Financial Agreement

I understand that my medical professionals will bill my insurance if it is present.My benefits have been explained to me and I understand that there may be some out-of-pocket expenses in the form of co-pays, co-insurance, and deductibles.

I understand that unpaid expenses will be my responsibility and are due as known at time of service and after the insurance remits.
I understand cancellations are to be 1 day for every hour of scheduling. If sessions are 2 hours, 2 days are expected cancellation before a visit. A $25 cancellation fee will result when the cancellation policy is not adhered to. In cases of illness, please know that much of our work can be done on patients suffering from minor ailments such as colds, flu, gastrointestinal issues, etc. and our work will be beneficial in helping you recover from these ailments. I understand I will be reimbursed for any overages I have paid that my insurance reimburses.