PAYMENT POLICY

Payment by insurance or cash accepted at time of service. Failure to pay for appointments at the time of service may result in termination of therapy.

Credit cards or debit cards accepted for payment at this time.

Sliding Scale

Patients requesting a sliding scale fee must provide proof of income (ie; paystub) and estimated monthly expensenses before their fee can be adjusted

Cancellation/

Attendance

Twenty four (24) hours notice is required for cancellation of appointments. Patients, or their parents/guardians in the case of minors, are personally responsible for payment in full for broken appointments. The only exceptions will be for documented emergencies. (a doctor's note).

Two (2) consecutive broken appointments may result in termination of therapy. I agree by signing below, to abide by the payment and cancellation/attendance policy.