PRIVACY POLICY

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Purpose: The following privacy policy is to ensure that Edmund Fisher Inc. dba Luz Lounge (LL)  complies with requirements of the Health Insurance Portability & Accountability Act of 1996 (HIPPA) as well as California privacy protection laws and regulations. Protection of patient privacy is of paramount importance to LL. Violations of any of these provisions knowingly or unknowingly will result in disciplinary action including termination of employment and possible referral for criminal prosecution.

Notice of Privacy Practices
This Notice of Privacy Policy will be provided to patients at their first encounter and all uses and disclosures of protected health information (PHI) will be accord with LL notice of privacy practices. LL will have copies of the most current Notice of Privacy Policy available for review posted on our web site www.LuzLounge.com

Assigning Privacy and Security Responsibilities
Specific individuals at LL are assigned the responsibility of implementing and maintaining the HIPAA Privacy and Security Rules’ requirements.

Deceased Individuals
LL privacy protections extend to information concerning deceased individuals.

Minimum Necessary Use and Disclosure of Protected Health Information
LL will ensure that for all routine and recurring uses and disclosures of PHI (except for uses or disclosures made for treatment purposes; to or as authorized by the patient; or as required by law for HIPAA compliance) such uses and disclosures of PHI must be limited to the minimum amount of information needed to accomplish the purpose of disclosure.

Safeguards
Appropriate safeguards will be in place at LL to reasonably protect health information from any intentional or unintentional use or disclosure that is in violation of the HIPAA Privacy Rule. These safeguards include physical protection of premises and PHI, technical protection of PHI maintained electronically and administrative protection of PHI. These safeguards will extend to the oral communication of PHI and to PHI removed from LL.

Business Associates
LL will ensure business associates comply with the HIPAA Privacy Rules to the same extent as LL, and that they be contractually bound to protect health information to the same degree as set forth in this policy. Business associates permitted to receive PHI include, for example LL billing service, patients’ health insurers, and other healthcare providers with whom we consult and coordinate patients’ care or to whom we refer patients for specialized care. 

LL will ensure that all employees are trained on the policies and procedures governing protected health information and how LLcomplies with the HIPAA Privacy.  New employees will receive training within a reasonable time of employment. 

Sanctions
LL will ensure that sanctions will be in effect for any member of the workforce who intentionally or unintentionally violates any of these policies or any procedures related to the fulfillment of these policies. Such sanctions will be recorded in the individual’s personnel file.

Retention of Records
LL will adhere to the HIPAA Privacy records retention requirement of six years. All records designated by HIPAA in this retention requirement will be maintained in a manner that allows for access within a reasonable period of time. This records retention time requirement may be extended at LL’s discretion to meet with other governmental regulations or those requirements imposed by our professional liability carrier.

Complaints
LL will investigate and resolve all complaints relating to the protection of health in a timely fashion. All complaints will be directed to Practice Manager, who is duly authorized to investigate complaints and implement resolutions.

Prohibited Activities-No Retaliation or Intimidation
No employee or contractor of LL may engage in any intimidating or retaliatory acts against persons who file complaints or otherwise exercise their rights under HIPAA regulations. No employee or contractor may condition treatment or payment on the provision of an authorization to disclose protected health information.

Cooperation with Privacy Oversight Authorities
LL will ensure that oversight agencies such as the Office for Civil Rights of the Department of Health and Human Services will receive cooperation in any investigation relative to protection of health information within LL.   All personnel will cooperate fully with all privacy reviews and investigations.

Investigation and Enforcement
In addition to cooperation with Privacy Oversight Authorities, LL will follow procedures to ensure that investigations are supported internally and staff of LL will not be retaliated against for cooperation with any authority. It is our policy to attempt to resolve all investigations and avoid any penalty phase if at all possible.

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REFUND POLICY

Your happiness matters to us, so before you ask for a refund, please contact our Manager to help process your return request faster or hopefully turn your experience around to a more positive one. 

Manager: Patty Rappa. CCC. Manager.

(310) 401-9001 E-mail: patty@luzlounge.com

 

If you are not happy with your product purchase we are happy to offer a full refund or exchange within 15 days of purchase, minus any shipping costs. 

 

All services purchased on promo or discount rates are final.  They may be exchanged for other spa or medical services of equal or lesser value. Exchanges on packages of treatments will be prorated back to a-la-carte rates and balances will be credited to your account accordingly.   Groupon or other services purchased through third party vendors are non-refundable if they have been started and vouchers have been redeemed.  Voucher specific services must be followed in accordance to the details of the voucher or simply not used at all.  Unused vouchers are refundable via the third party it was purchased through.  Any un-used service or service package purchased at full retail rate or menu rate is 100% refundable within 30-days of purchase.  

 

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Lüz Lounge
1229 Montana Ave STE A Santa Monica CA 90403
310.401.9001
 

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Review Luz Lounge Privacy Policy

Ultherapy/HIIFU Consult and Consent for treatment at Lüz Lounge

The Ulthera® HIIFU Systems delivers a low amount of focused ultrasound energy to the skin. The heat from the ultrasound stimulates new collagen to form. I understand that there can be discomfort during the treatment when the ultrasound is being delivered. I’ve discussed with my practitioner the options available to me to optimize my comfort during the procedure. 


Immediately following Ultherapy®/HIIFU, the skin may appear red for a few hours. It is not uncommon to experience slight swelling for a few days following the procedure or tingling/tenderness to the touch for days to weeks following the procedure, but these are mild and temporary in nature. 


 

Occasional temporary effects may include bruising or welts, which resolve in hours to days, or numbness in a select area, which resolves in days to weeks. 


As with any medical procedure, there are possible risks associated with the treatment. There is a remote risk of a burn that may or may not lead to scarring (either of which will respond to medical care), or temporary nerve inflammation, which will resolve in a matter of days to weeks. Temporary local muscle weakness may result after treatment due to inflammation of a motor nerve. Temporary numbness may result after treatment due to inflammation of a sensory nerve. 


 

It has been explained to me that the results vary from patient to patient, and, occasionally, the collagen building on the inside that helps counter the effects of gravity does not have a visible effect on the outside. I understand that results will unfold over the course of 2 to 3 months and that some patients may benefit from more than one treatment. I also understand that a non- invasive Ultherapy treatment is not intended to produce the same results as an invasive surgical procedure.


I consent to photographs and digital images being taken and used to evaluate treatment effectiveness, for medical education, training, professional publications or sales purposes. No photographs or digital images revealing my identity will be used without my written consent. If my identity is not revealed, these photographs and digital images may be used, shared, and displayed publicly for such stated purposes without my permission. 


Before and after treatment instructions have been discussed with me. The procedure, potential benefits and risks, and alternative treatment options have been explained to my satisfaction.


This consent was read and signed while I was not under the influence of medications that might alter my mental capacity to understand its contents. I am advised that though good results are expected, the possibility and nature of complications cannot be accurately anticipated and that, therefore, there can be no guarantee as expressed or implied either as to the success or other result of the treatment. I am aware that Ultherapy treatment is not permanent as natural degradation will occur over time. 


 

I authorize Luz Aesthetics to take photos and/or video for sole purpose of education with marketing materials on our website, social media.  All photos and videos are kept in patients file with a  HIPPA compliant database only accessible to Luz Aesthetics staff. I understand I not be reimbursed for usage. I understand and agree that these materials shall become the property of Luz Aesthetics’s and will not be returned.


December 23, 2024

 

I understand I’m getting consulted and treated by Dr. Edmund Fisher’s Nurse Practitioners and Registered Nurses today


December 23, 2024

I hereby give my voluntary consent to this procedure and release Dr. Edmund Fisher MD, his medical staff, and specific technicians from liability associated with the procedure. I certify that I am a competent adult of at least 18 years of age and am not under the influence of alcohol or drugs. This consent form shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assigns. I agree, if I should have any questions or concerns regarding my treatment/results I will notify Luz Aesthetics and Dr. Fisher MD immediately so that timely follow-up and intervention can be provided  

December 23, 2024

 

 

CALIFORNIA MEDICAL SERVICES CONTRACT  

All Medical treatments are performed by Edmund Fisher Inc. dba Luz Lounge

A signed copy of this document is to be emailed/given to the client upon request. Original is to be filed in Client’s medical records. 

Arbitration Agreement California CD0501Y8v2 

 

ARTICLE I: ARBITRATION 

Article 1.1: Agreement To Arbitrate: It is understood that any dispute as to medical malpractice by Client, including any party that would have standing to assert a claim on behalf of or in connection with services provided to Client, that is as to whether medical services rendered under this contract were unnecessary, unauthorized or lacking informed consent or were improperly, negligently, or incompetently rendered, will be determined by submission to arbitration as provided by California law, and not by a lawsuit or resort to court process except as California law provides for judicial review of arbitration proceedings. For purposes of this agreement, “Dispute” means any claim or controversy of whatever kind or nature including (without limitation) any claim or controversy regarding the formation, validity, interpretation and/or enforceability of this agreement to arbitrate and any claim or controversy by the Client asserting loss of consortium, wrongful death, emotional distress or punitive damages.  Both parties to this contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.  

Article 1.2: Procedure For Initiating Arbitration: Either party to this agreement may initiate Arbitration by submitting a Demand for Arbitration in writing to the other. The Demand shall contain a plain and simple statement of the nature of the Dispute and the remedy demanded. There shall be one Arbitrator who shall be a retired Judge of a court of record. The Arbitrator shall be selected by agreement of the parties on or before 30-calendar days of the date that the Demand for arbitration is deposited for delivery with a common carrier (as determined by a postmark or other equivalent writing imprinted by the common carrier). If the parties have not agreed to a selection of the Arbitrator, than either party may petition the appropriate Superior Court to appoint the Arbitrator and, consistent with CCP § 1281.6, the Superior Court shall appoint the Arbitrator, who shall have the qualifications stated in this paragraph. 

Article 1.3: Law Governing Arbitration; Arbitrator’s Award And Enforcement. Without reference to its choice of law rules, the Arbitrator shall apply the substantive law of California. The Arbitrator shall render his or her award in writing and the award shall separately state the Arbitrator’s findings of fact and conclusions of law. The Arbitrator’s award shall be binding on the parties to the arbitration and judgment on the award may be entered by a court of competent jurisdiction in California. Judicial proceedings to confirm, amend, or vacate the arbitration award shall also take place in California. To the extent permitted by law, venue for such proceedings shall be in the county (or the federal judicial district) where the services were rendered. Unless the Arbitrator shall determine otherwise, the Arbitration shall take place in the county where the services were rendered. The Arbitrator shall have the authority to hear any claim and award any remedy that could otherwise be heard or rendered by the Superior Court of California or a federal district court in California. Discovery shall proceed in accordance with California Code of Civil Procedure, §§ 1283.1, 1282.05, and, in addition, any party, may, of right, bring a motion for summary judgment or adjudication in accordance with CCP § 437c. The parties to this agreement agree to arbitrate in one proceeding all claims arising out of the same or a related incident, transaction or occurrence. 

Article 1.4: Small Claims Court: Notwithstanding the foregoing any party to this agreement may initiate and prosecute in the small claims division of the Superior Court any claim at law demanding an amount equal to or less than the jurisdictional limit of the small claims division. Notwithstanding applicable law, no judgment in an action initiated in the small claims division may be entered for an amount in excess of the jurisdictional limit of the small claims division. 

Article 1.5: Severability: If any provision of this arbitration agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provisions.

NOTICE: BY SIGNING THIS CONTRACT YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY MUTUAL ARBITRATION AND YOU ARE GIVING UP  YOUR RIGHT TO JURY OR COURT TRIAL. 

I have read and agree to the terms/conditions listed in this agreement and understand that I have the right to receive a copy of this arbitration agreement upon request.

 

December 23, 2024

Please select who is receiving the consult/treatment today
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First Client's Name

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Last Name*
First Client's Age Acknowledgment*
First Client's Date of Birth*
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First Client's Information

Social Security Number *
First Client's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Clinical response factors
Upper Face Skin Laxity (Excess skin or hooding on the eyelids, eyelid droopiness)*
Upper Face Volume (Presence of fat deposits under eyes; puffiness)*
Upper Face Skin Quality (Fine lines/Wrinkles, crepiness and/or poor elasticity)*
Lower Face and Neck Skin Laxity (excess skin or jowls)*
Lower Face and Neck Volume (presence of fat deposits in lower face, loss of jaw/chin definition)*
Lower Face and Neck Skin Quality ( Fine lines, wrinkles, crepiness and/or poor elasticity)*

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Additional services
I'm interesting in learning more about...Select all that apply
Acne Laser Facials
Botox
Chemical Peels
ClearLift Laser Facial
Coolsculpting (Fat Reduction/Body Contouring)
Cortisone Injections
Juvederm/Dermal Fillers
Developing a Customized 3, 6 or 12 Month Skin Care Plan
Eyelash Extensions
Facials
General Skin Care Consult
Improving uneven skin texture
IPL (Intense Pulsed Light)
Laser Hair Removal
Microneedling
Microblading Eyebrows
Microdermabrasion
Platelet Rich Plasma (PRP) Facial and/or Hair Restoration
Reducing Melasma (Pregnancy Mask)
Reducing Rosacea
Red Light Therapy/Infrared
Removing Broken Capillaries
Removing Brown Spots/Sun Damage
Skin Tightening
Tattoo Removal
Teeth Whitening
Ultherapy or High Intensity Focused Ultrasound (HIFU)
Vitamin B12 Injections
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Social Security Number *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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