Terms and Agreement: We are very pleased to welcome you to Leon NP Family Health Care, PLLC (the “Practice”). Please read the following important information carefully regarding your financial responsibility for the care and services provided by the Practice. By agreeing to be treated by the Practice, you consent to the following terms and conditions.
Practice and its providers do not participate with any insurance plan, and all services rendered by the Practice are considered out of network services that may not be reimbursable under your insurance plan. You acknowledge and understand that the services provided by the Practice are also generally considered non-covered services under most insurance plans. It is your sole responsibility to know and understand your insurance plan benefits prior to your visit. Elective services and procedures are generally not covered by Insurance.
You understand that you are solely financially responsible for the cost of all services provided to you by Practice and its providers. All services must be paid for by you at the time of service unless the Practice has set forth a separate written payment arrangement with you for the services. Regardless of your individual insurance coverage or type, as the person seeking care and treatment, you are ultimately responsible for all charges for services rendered by the Practice and its providers. The Practice does not submit any out of network claims for the services it provides. At your request, Practice may provide you with an invoice if you choose to seek reimbursement from your insurance plan.
All outstanding balances must be paid in full prior to the next office visit or receiving further treatment. By signing this document, you acknowledge that you are fully aware that Practice and its providers are out-of-network providers and you would like Practice to render the professional services for your benefit at your own expense.
In compliance with applicable federal and state law which mandates transparency on expected fees, upon request Practice will provide a fee schedule which contains fees for services rendered by Practice as needed based on clinical considerations. Please be aware that fees are subject to increase at any time. You may obtain an updated fee schedule at any time by requesting a copy from the Practice.
In the event you are scheduled for a series of treatments as part of a treatment plan, you understand that you are responsible for the entire cost of the whole series of treatments, due to Practice prior to completion of the treatment. There are no exceptions to not receiving payments for all scheduled services, including death, travel, or decision to end treatment early. You understand that upon completion of a session you will not be entitled to any reimbursement, regardless of efficacy or results. You understand that there are no refunds and no exceptions even if you no longer wish to continue or complete the treatment session(s). You are fully financially responsible for all sessions in your treatment plan. You may use the remaining unused balance towards another treatment only upon discussion and prior approval of the Practice.
Deposit Policy: At the time of your online booking, the Practice requires a fee of $25 for the initial consultation. If you decide to proceed with your treatment of choice at the time of initial consultation, the Practice requires a deposit of $100 to schedule any future treatments. The Practice will collect the remaining balance on the first day of treatment or day of single treatment, as applicable. All deposits are non-refundable.
Return Policy: All deposits, treatments, procedures and/or pre-paid packages are nonrefundable. Packages are non-transferable and must be used within one year from date of purchase. Products are nonrefundable. Credit may be applied toward other forms of treatment(s) or products only at management discretion.
Cancellations Policy: Your appointments and well-being are very important to us. We understand that sometimes, unexpected delays can occur, requiring schedule adjustments. If you need to cancel your appointment, we respectfully request at least a 24 hour notice. Any cancellation or reschedule made less than 24 hours will result in a cancellation fee of $25. If you are more than 20 minutes late for your service, we may not be able to accommodate you. We will do our best to reschedule your service for another time that is convenient. We require a credit card to hold your appointment. Cancellation fees will be charged to your card on file. In the event of a true, unavoidable emergency, all or part of your cancellation fee may be applied to future services.