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 Lüz Lounge (LL) complies with requirements of the Health Insurance Portability & Accountability Act of 1996 (HIPPA) as well as Texas 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. 

General Manager: Patty Rappa. CCC. Manager.

(310) 401-9001 ext. 2

 

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 

4801 Woodway Dr. #465E

Houston

713-960-4021


Review Lüz Lounge Privacy Policy

Laser LüzLounge Informed Consent

I duly authorize and consent Lüz Lounge  to perform Laser Treatments and any other measures which in their opinion may be necessary. 

I understand that clinical results may vary in different skin types and hair types and that my pre/post care instructions must be adhered to in order to achieve optimal results. I understand there is a possibility of short-term effects such as reddening, blistering, scabbing, temporary bruising and temporary discoloration of the skin, as well as rare side effects such as scarring and permanent discoloration. These effects have been fully explained to me.

Clinical results may vary depending on individual factors, including medical history, skin and hair type, patient compliance with pre/post treatment instructions, and individual response to treatment. I understand that laser hair removal involves a series of treatments and may require additional sessions and/or touch ups and that the fee structure has been fully explained to me.

I certify that I have been fully informed of the nature and purpose of the procedure, expected outcomes and possible complications, and I understand that no guarantee can be given as to the final result obtained. I am fully aware that my condition is of cosmetic concern and that the decision to proceed is based solely on my expressed desire to do so.  

I confirm that I am not pregnant at this time and will inform Lüz Lounge staff if I become pregnant. 

I confirm that I have not taken Accutane within the last 6 months and will inform my tech if I am prescribed Accutane during my treatment series and discontinue my sessions immediately.  

I confirm that I have not and will not use any topical retinoids on the desired treatment area for 2 weeks before and 2 weeks after my laser treatment and that Lüz Lounge  and its medical staff are not responsible for any complications or additional treatments that arise from doing so.

I consent to the taking of photographs/videos and authorize their use for the purposes of medical audit, education and promotion. ( If you do not consent, put an "X" in as your inital)

October 17, 2021

I understand that there is a $10 shaving charge if I have come to my appointment unshaved.( Please let us know if you need assistance shaving so we can allow enough time for your treatment)

October 17, 2021

I certify that I have been given the opportunity to ask questions and that I have read and fully understand the contents of this consent form. 

October 17, 2021

I understand I’m getting authorized to treat by Dr. Noam Rosines medical staff and Certified Laser Techs today

October 17, 2021

 

 

TEXAS LASER SERVICES CONTRACT 

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 Texas.

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 Texas law, and not by a lawsuit or resort to court process except as Texas 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 Texas. 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 Texas. Judicial proceedings to confirm, amend, or vacate the arbitration award shall also take place in Texas. 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 Texas or a federal district court in Texas. Discovery shall proceed in accordance with Texas Code of Civil Procedure, and, in addition, any party, may, of right, bring a motion for summary judgment or adjudication in accordance with TCCP 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.  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.   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.

 October 17, 2021


 

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

First Name*

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

Please list any and all current medical conditions. If none, leave blank.

Please list all medications you are taking, including supplements and multivitamins. If none, leave blank.

Please list any allergies. If none, leave blank.
Have you ever had Laser Services in the past?*
No
Yes
Are you currently on any antibiotics?*
No
Yes
Have you been prescribed Accutane within the last year?*
No
Yes
Any history of keloid scaring?*
No
Yes
Any history of cold sores?*
No
Yes
Any history of genital herpes?*
No
Yes
Is the desired treatment area currently tanned?*
No
Yes
Do you use sunscreen regularly?*
No
Yes
Within the last 10 days, have you used any vitamin A derivatives on the desired treatment area? (ex Retin-A or retinol)*
No
Yes
First Client's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please list any and all current medical conditions. If none, leave blank.

Please list all medications you are taking, including supplements and multivitamins. If none, leave blank.

Please list any allergies. If none, leave blank.
Have you ever had Laser Services in the past?*
No
Yes
Are you currently on any antibiotics?*
No
Yes
Have you been prescribed Accutane within the last year?*
No
Yes
Any history of keloid scaring?*
No
Yes
Any history of cold sores?*
No
Yes
Any history of genital herpes?*
No
Yes
Is the desired treatment area currently tanned?*
No
Yes
Do you use sunscreen regularly?*
No
Yes
Within the last 10 days, have you used any vitamin A derivatives on the desired treatment area? (ex Retin-A or retinol)*
No
Yes
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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