By Signing Electronically, You Agree to the Terms: I understand that full disclosure is necessary to my medical safety. I acknowledge that I have provided all of my personal and medical history accurately.

Your information is not shared or sold. Your health information is kept private only to be seen by Hospital BC and necessary parties involved.

By agreeing to these terms and conditions you OPT-IN to being contacted by Hospital BC via Text Messages, Email, and/or Phone. To opt-out, simply reply “STOP”. Your information is NEVER sold or used by 3rd party companies.

1. All information that you are required to provide with this Health Questionnaire, as well as any other medical information thereafter, is required to be truthful, complete, and accurate. If it is not accurate, the surgeon can cancel your surgery resulting in the loss of security deposit and all monies paid for the surgery.
2. It is imperative that the height and weight reported on the Health Questionnaire be accurate. ALL patients are weighed and measured before surgery. If the BMI (Body Mass Index) at the time of surgery does not accurately reflect the height and weight reported on the Health Questionnaire, the surgeon(s) may exercise their right to forego the surgical procedure and any deposit made will be forfeited.
3. If you decide to schedule your surgery, we reserve the right to be able to contact you via phone, email, and/or text. Any previous settings for those communication methods to be disabled will be overridden.

Deposit, Refund, & Cancellation Policy (If Surgery is Scheduled)

Hospital BC posts its deposit, refund, and cancellation policy that is documented on the Health Questionnaire (HQ) and the Consent Form. This policy applies to all surgeries types offered through Hospital BC. Please contact your patient coordinator if you have any questions regarding these policies.

Deposit and Booking Bariatric Surgery

1) Security Deposit: A deposit of $500.00 non-refundable (U.S. dollars) must be made on the day of scheduling your surgery. Any deposit under $500 USD is non-refundable.

2) Remaining Balance Deposit: The client is required to pay the entire remaining balance on the day of surgery and must be paid with a CASHIER’S CHECK made payable to Hospital BCN

Refunds and Cancellation Policy

The following policy applies to scheduled deposits:

Please make sure all refunds and cancellations are in writing. All scheduling deposits are refundable only for a MEDICAL REASON. The request must be made in writing no less than thirty-one (31) days before the scheduled surgery date. A written letter from a medical professional is required if made in writing no less than thirty-one (31) days before the scheduled surgery date.

No refunds are made within fourteen (14) days before the surgery date.

Patients can only Reschedule or postpone once (1), allowing patients to re-use the scheduling deposit for another surgery date.  Patients who reschedule more than once or 15 days less than their surgery date will have a $250.00 administration fee will be applied. Rescheduling is not possible within 10 days before surgery. A written letter from a medical professional is required to postpone the surgery. Patients can only postpone once (1).

Medical/Surgeon Cancellation Policy:

If the surgery is canceled at the doctor’s request because of the following issues:

Non-compliance Policy. The patient did not follow pre-operative instructions, the patient falsified or omitted information on the health questionnaire, misled Hospital BC, the Patient was not cleared for surgery, the entire loss of the scheduling deposit, and all payments made for the procedure are forfeited.

If the surgeon tries to perform the surgery but encounters an issue preventing safe surgery, the surgeon has the right to cancel the surgery. No refunds or partial refunds are returned for canceled surgeries.

No-Communication Policy:

If 10 days or less the patient fails to communicate and/or respond to communication attempts Hospital BC reserves the right to cancel the scheduled surgery and all monies are forfeited by the patient.

After Travel

1) If surgery is CANCELED for reasons such as no show, noncompliant with the pre­-operative instructions, incomplete documentation, financing issues, rule-breaking, cold feet, etc., the $500.00 deposit with be forfeited due to miscellaneous costs incurred by Hospital BC, including but not limited to transportation, hotel accommodations, pre-­op test(s), doctor fees, etc.

2) If surgery is CANCELED/POSTPONED due to medical conditions discovered during the pre-operative tests or if it is determined that the operation cannot proceed due to safety reasons, the $500.00 deposit will be forfeited due to miscellaneous costs incurred by Hospital BC, including but not limited to transportation, hotel accommodations, pre-­op test(s), doctor fees, etc.

3) If the procedure was not completed and the surgical team determined the operation could not be performed safely, there will be NO REFUNDS.

Miscellaneous Rules

– All cancellations must be received by Hospital BC in writing, via email, or fax.

– I understand I am responsible for any fees my credit card provider may charge for card usage outside the U.S.

– Agreeing to the refund policy is bound by our most updated policy on our website at the time of cancellation.

– Hospital BC reserves the right to change our refund policy at any time*

Last Updated: 09/01/2024

Additional Fees (If Applicable)

I agree to the Additional Fees (if applicable). **These fees only pertain to certain patients. You have no obligation unless you decide to move forward with the process. **

⮞ High BMI 49+ – $500.00

⮞Double High BMI 60+ – $1000.00

⮞ Extra Hotel Nights – $125.00

⮞ Hiatal Hernia – $750.00

⮞ Endoscopy – $750.00

⮞ Extra Night Hospital – $150.00

⮞ Open Surgery/Abdominal Trauma – $995

⮞ HIV – $750.00

⮞ Hepatitis B – $750.00

⮞ Hepatitis C – $750.00

⮞ Gallbladder Removal – $750.00

⮞ Blood thinner injections (If needed when discharged).

⮞ Meals for a companion

* Prices subject to change without notice. Additional charges may also apply for patients with certain medical conditions, medications not included in standard post-op orders and/or for procedures not included in the initial surgical procedure (i.e.; Hiatal hernia repair etc.)

All fees stated are in USD and include a cash discount. A 5% additional fee is required for credit card payments. (Visa, MasterCard, American Express & Discover).