IHI ND - Tiered Payment Options

IHI Naturopathic Medicine Payment Form

Please choose the option that best suits your needs
At Inside Health Institute, we believe that whole person care services should be accessible to all. To accomplish this, we do not take insurance because insurance companies often cause a variety of complicated care, cost, and administrative barriers that create challenges in providing our clients the services they need and deserve. Instead, we offer a payment system that allows you to choose from four fixed tiers to determine how much you pay for your visits, without providing income verification. Those who have the means to pay more allow those who might otherwise not be able to afford services receive them at the lower rate. If your financial circumstances change during the course of therapy, as we know life is complicated, please let your provider know and you will be provided a form to adjust your payment tier.
We use this payment tier to minimize limitations in accessing ND care. We want you as the client to determine the price that you pay for Naturopathic Medicine. Please indicate the fee you agree to pay:

Naturopathic Medicine Visit - $180 - 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.Naturopathic Medicine Visit - $130 - 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 savingsNaturopathic Medicine Visit - $90- 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.Naturopathic Medicine Visit - $60 - 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 options
Please tell us anything you would like us to know about your current financial challenges if applicable
Name*

First NameLast Name
Email*
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Phone Number*
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Please insert your card information below. We require all clients, regardless of how much they pay, to have a credit or debit card on file. We accept Mastercard, Visa, American Express, or Discover cards. Clients will automatically be charged within a week of their appointment, unless they otherwise specifiy that they would like to pay via cash or check on the day of the appointment. By signing below, you agree to this charge.

Please write any special instructions or requests below regarding payment processing. This does not exempt you from having to provide a card on file, but we will make note of payment preferences for each client. If you ever need to change the card on file, please contact your provider or IHI directly and you will be provided a form to update your card. If you have questions please reach out to IHI at 425-256-2125 or resourcedirector@insidehealthinstitute.org.

Cancellation and No Show Policy:

Please note, our policy is that we reserve the right to charge you a $10 fee, regardless of how much your appointment fee is, after two no shows or cancellations with less than 24 hours notice.

Our payment processes are PCI DSS compliant. Your card information is protected.
Card Type*
Card Number*
Expiration Month and Year*
CVV Number (Security Code)*
Name on Card*
Street Address*
Zip Code*
Email that receipts should be sent to*
Any special instructions or requests for payment processing
Signature*

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IHI Naturopathic Medicine Payment Form