By submitting my photos online and by signing below, I acknowledge and understand that the New Look Now, LLC electronic imaging simulation system is only a rough approximation of what I may be able to achieve with cosmetic or surgical procedures. 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 nor replace medical advice or an in-person cosmetic consultation. I understand that the outcome of any cosmetic or surgical procedure and the appearance of any scars will be directly related to my individual healing characteristics. Because of the significant differences in the types of cosmetic and surgical procedures available, and how living tissue heals, there may be little similarity between the electronic images generated and my final cosmetic or surgical results.
By using the electronic imaging simulation system, I acknowledge and agree that New Look Now, LLC, and the provider or the physician reviewing my photos or generating new images make no warranty of any kind, expressed or implied, with respect to my ability to obtain the look illustrated in these electronically altered images. I understand that the information provided on this website and the electronically altered images generated may not be construed as medical care or medical advice, and are not a replacement for medical care given by physicians or trained medical personnel. I understand and acknowledge that in order to find out the cosmetic or surgical procedures available to me, to develop reasonable expectations, and to be fully informed of any risks, I have been advised to schedule an in-person consultation with a licensed cosmetic services provider or 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.