Private Pay Patient

I agree to accept full responsibility to provide payment at the time service is rendered, with applicable discounts applied. On special occasions I may have arrangements made to have my services billed to me. I understand that the terms of this office are to pay the balance within 30 days of the most recent statement (net 30 days Balances not paid within 30 days may be charged a rebilling fee. If a balance is not paid within 90 days, and my account is sent to a collection agency. I understand that I am responsible for any additional collection and / or attorney fees related to my delinquency.

Health insurance Patients:  

Insurance billing is a not courtesy that this office extends to our patients. I understand that can request a superbill be provided by this Tend Natural Medicine that I can then submit to my insurance provider.I understand that it is to my benefit to confirm my coverage by calling my health insurance customer service representative.

CANCELLATION POLICY: If you are unable to keep an appointment, please give the office 24 hours notice. There is $50 office fee for missed or canceled appointments without 24 hours notice. This fee is your responsibility and cannot be billed to any insurance.

Tend Natural Health 

4531 SE Belmont Ste 313

Portland, OR 97215

drkate.sydncy@gmail.com