By submitting my photos online and by signing below, I acknowledge and understand that the electronic imaging simulation system is only a rough approximation of actual post-operative appearances. I further understand that the newly generated images showing the result of an alteration of my images is purely for the purpose of illustration and discussion and does not constitute any medical advice or consultation. I understand the outcome of any surgical procedure and appearance of any scars is directly related to my individual healing characteristics. Because of the significant differences in how living tissue heals, there may be little similarity between the electronic images and my final surgical result.
I certify my understanding that there is no warranty of any kind, expressed or implied, provided by either the physician reviewing my photos or generating new images, or New Look Now, LLC., as to my final appearance by the use of these electronically altered images. I understand that no information provided on this website nor image generated electronically may be construed as medical care or medical advice and is not a replacement for medical care given by physicians or trained medical personnel. I understand and acknowledge that in order to receive a full understanding of the surgical procedure and be fully informed of my risks, I have been advised to schedule an in-person consultation with a licensed surgeon specializing in cosmetic surgery.
Authorization To Disclose Health Information
New Look Now, LLC is a referral network comprised of third party members and member physicians. New Look Now, LLC is not a provider and not a covered entity under the Health Insurance Portability and Accountability Act (“HIPAA”). Nonetheless, New Look Now, LLC requires your consent to provide certain personal information that you provided to New Look Now, LLC to its members and member physicians.
Accordingly, I authorize New Look Now, LLC to provide its members and member physicians with my personal and health information, including, but not limited to, my name, zip code, telephone number, e-mail address, simulated photo, and any information I provided to New Look Now, LLC related to my health care, past and present physical condition, and surgical choices and preferences.
I understand that I have the right to revoke this authorization, in writing, at any time. I understand that a revocation is not effective to the extent that New Look Now, LLC already has acted in reliance on my authorization.