Terms and Conditions

NSI Office Policies and Patient Agreement

Welcome to NSI. We are honored to care for you and committed to delivering a high quality experience tailored to your needs and goals. To ensure a smooth visit and the best possible care, please review and acknowledge the policies below.

1) Required Paperwork (Patient Portal)

All required patient portal forms must be completed at least one (1) day prior to your appointment so Dr. Tolman can review your information in advance. Depending on your appointment type, additional forms may be required. Failure to complete required forms by the deadline may result in appointment cancellation.

2) Arrival Time and Late Arrivals

Please arrive ten (10) minutes early to allow time for check in and questions. If you anticipate being late, call our office as soon as possible. Appointments are scheduled with dedicated time blocks, so late arrival may reduce your visit time and we may not be able to extend your appointment.

3) Emergencies

For urgent or potentially serious symptoms, including but not limited to progressive arm or leg weakness or numbness, loss of bowel or bladder control, or a severe medication reaction such as fever with increasing pain, trouble breathing, or shock like symptoms, please go to the nearest emergency room. The ER team will contact us if appropriate.

4) Phone and Message Response Policy

If you leave a voicemail, our team will make every effort to return your call within one (1) business day. Please leave a detailed message. Calls are returned based on medical urgency as assessed by our clinical team. Portal messages and email are not monitored for urgent issues. Please call for time sensitive concerns.

5) Credit Card on File and Deposits

All patients are required to have a credit card on file. When booking an appointment online or over the phone, a portion of the service fee will be charged to the card on file and automatically credited to the patient wallet. Wallet funds will be applied as payment toward the service at the time of your scheduled appointment and must be redeemed within one (1) year from the date processed. A 3.5 percent card processing fee applies to payments made with any type of card, including Visa, MasterCard, Discover, American Express, debit cards, or charge cards, and may appear on your receipt as taxes or as a separate processing fee.

6) No Show Policy

If you do not attend your scheduled appointment and do not provide notice, the card on file may be charged seventy five (75) percent of the scheduled procedure cost. This appointment time could otherwise be allocated to another patient.

7) Cancellation and Reschedule Policy

Cancellations or appointment changes require at least two (2) business days notice. Failure to provide sufficient notice will result in a 100 dollar charge to the card on file.

8) Declined Payments and Administrative Reinstatement Fee

If a patient payment method is declined for a membership or transaction, a 150 dollar administrative reinstatement fee will be applied to the account to cover failed processing and account reactivation. Payments may be processed automatically using the card on file. When a payment is declined, the reinstatement fee is charged, becomes the patient responsibility, and is due upon notice.

9) Dispute and Chargeback Policy

Any chargeback or payment dispute submitted by a patient, including disputes through a financing company such as Cherry or through a credit or debit card issuer, requires administrative review and documentation. A dispute or chargeback fee may be applied based on the amount disputed and the administrative burden incurred. This fee may apply regardless of the outcome of the dispute.

10) Repeated Disputes

Repeated or excessive disputes may result in suspension or termination of membership benefits, restriction to cash only payment for future services, revocation of online booking privileges, and or refusal of future non emergent services.

11) Payment Method Updates

Patients are responsible for maintaining an active and valid payment method on file, including updating expired cards, replacement cards, billing addresses, or other changes needed to ensure successful processing.

12) FDA and Off Label Use Notice

You understand that the FDA regulates approval and use of drugs and medical devices. In medical practice, off label use of FDA approved medications or devices is common and may be clinically appropriate. Your care plan may include off label use when medically indicated based on current evidence and individual needs.

13) Lab Orders

Certain care plans include lab orders. After initial courtesy lab orders and follow up intervals, such as one (1), six (6), or twelve (12) months, a 30 dollar fee applies for replacement lab orders that are lost or misplaced. Lab testing fees are billed directly by the laboratory and are not included in NSI office fees.

14) Refund Policy

All purchases are non refundable. Unused balances from treatment packages may be credited to your patient wallet unless fees apply under the cancellation or no show policy. Wallet funds must be used within one (1) year of being credited. You acknowledge that once a procedure is booked and prepared for, supplies including sterile equipment and medications are non returnable and non reusable. As a result, procedure costs are non refundable once booking is confirmed or a procedure has commenced.

Legal Addendum: Premises Safety & Inclement Weather

NSI takes reasonable steps to maintain safe access during inclement weather; however, we cannot guarantee elimination of all hazards. By entering the premises during adverse weather conditions, you acknowledge and agree:

Acknowledgment

You confirm that you have read, understand, and agree to these policies and terms. You acknowledge you are eighteen (18) years of age or older and understand this is an important legal document.