IHI ND - Tiered Payment Options

IHI Naturopathic Medicine (ND Visit) Payment Form

Please choose the option that best suits your needs
Payment Tier Selection/Billing Information

At Inside Health Institute, we believe whole-person care should be accessible to everyone. We use a simple, honor-based payment tier system to keep care accessible for everyone. We don’t bill insurance, as insurance often creates barriers to timely, personalized care. Please select the payment tier that best reflects your current circumstances. There is no income verification, and you may adjust your tier at any time if your situation changes—life happens.Those who are able to pay at higher tiers help make care available to others, supporting dignity, access, and community care. Our lowest tier for counseling is $30 per session, which covers the basic cost of providing services.
Please select the fee you’re comfortable paying for your Naturopathic Medicine visits.*

$180 /ND Vist - I can comfortably meet my basic needs My finances are stable I have adequate savings I am in the financial position to compensate my provider so that those who are not in my financial position may still receive services.$130/ND Vist - I am able to meet my basic needs. Paying for ND care is not a financial hardship for me at this time. My finances are usually stable but may fluctuate I have some savings$90/ND Vist - My basic needs are met most of the time, but they are not always guaranteed. Paying for therapy may become burdensome to my financial well-being. My finances sometimes fluctuate. I do not have much savings.$60/ND Vist - I am experiencing financial hardship and many of my basic needs are not consistently being met.Check this box if none of these rates suit your neds right now and you would like to discuss other payment optionsOther
Please tell us anything you would like us to know about your current financial challenges if applicable
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Card Type*
After submitting this form:
- You will receive a $1.00 invoice from Stripe by email
- You’ll be asked to add and save a payment method securely
- This allows us to bill you after each visit, based on the tier you selected
- Your card will be charged within one week of each appointment
What Happens Next

The $1.00 charge is a one-time verification and will be applied to your next visit.

Why We Do This

Saving a payment method helps us:
- Reduce administrative follow-up
- Keep costs lower for everyone
- Focus our time on care, not billing logistics
Your payment information is encrypted and securely stored by Stripe. We never see or store your full card details.

If your financial situation changes, your tier can be adjusted at any time.

An IHI staff member may contact you if we need to confirm or update your payment information.

Questions or billing support: 📞 425-256-2125 ✉️ info@insidehealthinstitute.org

Cancellation & No-Show Policy

After two no-shows or cancellations with less than 24 hours’ notice, we may charge a $10 fee, regardless of your session rate.
Name on Card*
Billing Address*
Zip Code*
Email that receipts should be sent to*
Any special instructions or requests for payment processing
Signature*

Clear
Should be Empty:

IHI Naturopathic Medicine (ND Visit) Payment Form

Payment Tier Selection/Billing Information