Dr. Stephen Gordon Lay Away Plan Requirements

1.Patient must have completely and accurately filled out all requested patient information. If someone other than the patient is payer, then that payer must provide requested information.

2.Patient (or payer) must have a job and be willing to have their employment status verified.

3.Patient must pay the required non refundable deposit to have a preliminary surgery date set. This date may be changed no more than two (2) times unless an additional deposit is paid.

4.The patient understands that these are very volatile economic times and that the price of the procedure may or may not change every 90 days. Any increases will become the responsibility of the payer.

5.Patient understands that all lay away surgeries must be paid for in advance of the procedure(s) being performed. Patient/payer will have no more than 12 months to complete pre-payment.

6.Payments ideally should be made at regular intervals such as weekly, bi-weekly or monthly.

7.Options for payment include credit card numbers we would have on file to make payments at agreed upon intervals, periodic cash or check payments made in person for which we would provide a receipt.

8.Any payments made which are discredited later (check doesn't clear, credit card doesn't work) may or may not result in discontinuance of the lay a way plan, with return of monies paid minus the deposit and any bank charges.