To help you get acquainted with the office, we have prepared this statement about our policies and fee schedules.
Please sign below to indicate that you have read and understand our guidelines.
Your appointment is time set aside for you to see the therapist. There is a twenty-four (24) hour cancellation policy. If you cancel an appointment less than 24 hours prior to its scheduled time, you will be billed the full visit fee.
A message may be left on voice mail at any time to cancel your appointment. The earlier you can inform us of a change in your plans, the more efficient use we can make of our time. We also respect your time and will make every effort to be punctual for your appointment.
Children must be supervised by their caretaker and remain in the waiting area unless they are being seen by a practitioner.
Please refrain from perfumes and hair spray for your appointment. Thank you.
Fees & Payments:
For all patients, unless otherwise agreed upon, we require payment for services at the time they are provided.
We supply a standard, itemized receipt that you may submit to your insurance company to request
reimbursement. We are unable to accept assignment from private insurance carriers. We are unable to accept Medicare patients at this time. Please call to check on insurance carriers accepted.
Checks returned from the bank will incur a $30.00 “returned check” fee to your account.
Thank you for taking the time to read this policy sheet. If you have any questions about our policy please ask them now.
We understand that you have come here to seek specialized treatment and we will endeavor to assist you in a speedy recovery, but of course we cannot guarantee any specific result.