2017 Monthly Skin Care Package Agreement
Monthly Skin Care Package entitles client to one skin rejuvenation treatment per month at a discounted rate of $88 (regularly $110) paid via recurrent monthly billing. Up to two (2) additional treatments may be purchased by the client for themselves at this rate per month and will be included in the billing cycle for the month they occurred.
Pre-paid treatments from previous months that are not used may rollover as “credits.” However, these “credits” expire December 31, 2017 and will not carry over beyond that time. Unused treatment “credit” may not be used to purchase gift certificates or products. All appointments are subject to the merchant’s 24-hour cancellation policy. Any appointments cancelled within 24 hours prior to the appointment time and all no-shows will be charged the $88 rate or count as a used rollover “credit.”
I (the client) understand that the Monthly Skin Care Package is an agreement commencing on the date the signed below and terminating December 31, 2017. I agree to recurrent monthly billing by the merchant (Anne Devereux, L.Ac./ Hands & Needles Acupuncture) during this period. Recurrent monthly billing will occur on the 28th of each month at a rate of $88. This rate includes one 90-minute skin rejuvenation treatment per month, which, if unused, may rollover only during the period of this agreement (2017) and be used at any point before this agreement terminates on December 31, 2017. Any unused treatment “credits” after December 31, 2017 are forfeited.
However, during the term of this Wellness Package agreement, I understand that I may receive the same reduced rate of $88 (regular price $110) for up to a total of 4 treatments per month. If I schedule and receive more treatments in a given month than I have unused pre-paid treatment “credits” for, I understand that my credit card will be charged $88 for each additional treatment at the end of the month those treatments occurred.
Upon enrollment, my bank/credit card is authorized to transfer funds to Hands & Needles Acupuncture, LLC according to this agreement. I agree to notify merchant of any changes in my account information or termination of this authorization at least 30 days prior to the next due date of the charges. I will not dispute merchant recurring billing with my credit card, so long as the amount corresponds to the terms indicated in this agreement. I understand that Hands & Needles Acupuncture, LLC will enter my credit card information into a secure and encrypted third-party system (NMI) solely for the purpose of recurrent monthly billing according to this agreement.
I understand that I am subject to a $25 service charge for any transaction returned for insufficient funds or invalid account information. The service charge will be added to my outstanding balance and will be charged at the next monthly billing date. Plan prices and benefits may be subject to change with 30 days notice from the merchant. Monthly plans are nontransferable between persons, and do not apply for insurance billing. I understand that if I do not use my monthly appointment I can carry over treatment “credits” only until December 31, 2017. It is my responsibility to verify and track any rollover “credits.” In the case of a failure to pay monthly dues, I will be liable for any reasonable costs and attorney’s fees incurred by the merchant or its agents in its efforts to secure payment.
Cancellation & Freezing:
I agree to notify merchant of my Monthly Skin Care Plan cancellation in writing at least 30 days prior to the next billing cycle. Cancellations made within 30 days of the next billing cycle are subject to a $25 fee. I understand that I may freeze my Monthly Skin Care Plan for a period of up to two months per year at a rate of $25 per freeze, and that my credit card will not be charged $88 per month nor will I accumulate treatment “credits” during the freeze period.
This agreement is available for signing via our Patient Portal or in office.