You authorize regularly scheduled charges to your credit card. You will be charged the amount indicated below each billing period. A receipt for each payment will be provided to you via email and the charge will appear on your credit card statement. You agree that no prior notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected.

Users

To an extent, additional users may be added to your account to receive benefits of your membership, including discounted pricing:

• You may add up to one additional adult user, excluding adult children under the age of 26.
• You may add any number of additional youth users (under age 18) or adult children under the age of 26.

Please note that appointment details (such as date, time, length, and credit used) may be shared between any users on the same account. Session details (such as goals and observations) will not be shared unless permitted by written consent separate from this form. For minors, session details shared with a parent are dictated by a separate document. 

Additionally, it is the responsibility of the users listed to communicate regarding allocation of appointments. It is not the responsibility of the LMMT staff to regulate credit use amongst users. 

Pausing a Membership

Memberships may be paused or frozen from within your Patient Portal. When pausing a membership, you may select one, two, or three months at a time. 

When a membership is paused, you will receive a confirmation email.

Notices received less than 10 days prior to the end of month may not be processed until after the first of the following month.

Membership Benefits

• Any change to benefits will not begin until the freeze goes into effect (the first of the month following the confirmation email).
• During a membership freeze, member(s) and additional users will not receive discounted pricing for any services received.
• During a membership freeze, Premier Members will not receive discounted pricing on gift certificates, free monthly virtual appointments, or use of Late Cancel Passes.
• Premier Memberships must be active for 6 or more rolling calendar months to receive Premier Member benefits.

Accrued Credits

• Accrued credits may be applied to appointment dates after the scheduled freeze start date if those dates are selected prior to the freeze start date. Once the freeze start date passes, we will be unable to apply credits to appointments made until the membership is active again. 

Courtesy Pause

• It is not of our interest or yours for you to accrue a substantial number of appointments without coming in. If we are unable to contact you to schedule appointments for three (3) consecutive months, we reserve the right to apply a courtesy pause to your membership for three months.
• If at the end of the courtesy pause we are still unable to reach you, your membership will be subject to cancellation. If your membership was active for less than 6 months, you will be subject to the cancellation fee outlined in Terms of Cancellation. 

 

Terms of Cancellation & Card Holder Agreements

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Life Moves Manual Therapies, LLC in writing of any changes in my account information, termination of this authorization, or changes in authorization amount at least 10 days prior to the next billing date.

I understand that no refunds are issued for membership payments made in accordance with this authorization form.

If the card on file fails to charge or is declined, I understand that does not relieve me of my obligation to pay the agreed upon membership fee, and I will make every effort to resolve the payment with LMMT staff within 10 days. Memberships not paid on or before the 10th of the month in which they are due are subject to cancellation and must be paid before re-activation. If cancellation occurs in less than 6 months of membership activation, I agree to be billed and make payment for any cancellation fee owed.

I agree to a $100 cancellation fee if cancelled in less than 6 months. I understand this fee is to offset any sign-up bonuses delivered to myself or a referring party upon signing up for membership.

Upon cancellation, I understand that services purchased expire when the membership expires, and that it is at the sole discretion of Life Moves Manual Therapies to allow use after the membership expiration date. I will make every effort to schedule any remaining appointments prior to the membership expiration date.

If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day.

I acknowledge that the origination of Credit Card transactions to my account must comply with the provisions of U.S. law.

I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this authorization form.