Financial Responsibility
Please read and type name in agreeable with each guideline. When complete, sign form at the bottom then submit. By signing this document you are stating that you acknowledge, understand and agree to the following financial responsibility policies:
I understand that a 50% non-refundable deposit is required at the time of booking.
I understand the remaining 50% balance is due anytime prior to 2 hours before the consultation. If payment is not received within 2 hours of the scheduled appointment, appointment is subject to cancellation and you will need to reschedule.
I understand that I need to provide a 48-hour notification if an appointment needs to be rescheduled or cancelled.
I understand that if I do not provide a 48 hour notification, I will be required to pay an additional deposit prior to scheduling another appointment.
I understand that there are no refunds under any circumstance, but credits for future appointments may be issued on a case by case circumstance.
Signature
Clear
Submit
Should be Empty: