Contact Info (your information is sent to us securely and will remain confidential) First Name Last Name Phone Number Email Address (Email) How did you hear about us? Comments / Questions *PATIENT APPOINTMENT SCHEDULING POLICY Welcome to the Elizabeth Roche Med Spa. We look forward to working with you to achieve your esthetic goals. In order to make a "new patient appointment", we require a $50 deposit to hold your appointment time. This $50 deposit is considered your "consultation fee" the day of your appointment. If you need to cancel or change your appointment we ask that you do so prior to 48 hours of your appointment time. Failure to do so will result in a $50 charge and considered a "late cancellation". It cannot be used to hold a future appointment. Failure to show up for a scheduled appointment results in a $50 fee. If you cancel your appointment prior to 48 hours, your credit card will be credited for the full amount. Please note that Monday appointments must be cancelled by 3:00pm the prior Friday since we are not always here on Saturdays. If you have any questions regarding our new patient appointment scheduling policy, please feel free to call us at 201-505-1020 address Perillo Plaza 577 Chestnut Ridge Road Woodcliff Lake, NJ 07677 phone 1-201-505-1020 FAX 1-201-505-1080 email info@elizabethrochemedspa.com