Terms of Service
Clinic Policies (please initial each section)
_________ Cancellation and Missed Appointments Policy: Scheduled appointment times are reserved for you. If an appointment is missed or canceled with less than 24 hours notice, you will be billed for half the appointment rate. Exceptions can be made if you are sick or have an unavoidable emergency; in these cases, please contact us as soon as possible to reschedule. If you are or will be more than 10 minutes late, your appointment may need to be rescheduled.
_________ Insurance Notice: Our Office does NOT bill insurance for any Brainworking Recursive Technique (BWRT), Nutritional consultation.
_________ Payment Policy: Full payment is required at the time of service. Payment plans are available for patients with financial hardship. Please note that due to the complex nature of body and mind, we cannot guarantee any specific desired result.
_________ Consult Records: In accordance with HIPAA Privacy Laws, I understand that I have the right to see or obtain a copy of my medical records. I also understand that Lavender Solutions has the right to require up to 30 days in which to organize and prepare the information. (Please note that if you wish to obtain a summary or copy of all your records, there may be a $25 documentation fee.)