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Payment, Cancellation Policy, & Late Payments
Financial Agreement payment is due according to the service agreement.Late payments may result in suspension or cancellation of services. A minimum of 2 hours’ notice is required for cancellations. No-shows and missed visits without proper notice may be charged the full scheduled service amount, including applicable travel, mileage, and fuel expenses. Client Initials:
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Due on the invoice due date. Any outstanding balance exceeding $50 that remains unpaid more than 24 hours after the invoice due date will be considered delinquent. The full remaining balance must be paid within 24 hours following the original due date. A late fee of $50 per day will be assessed on all overdue balances until the account has been paid in full.To avoid additional financial liability for nurses, physicians, and other healthcare professionals assigned to the case, all future appointments, treatments, visits, and scheduled services may be suspended or canceled until the outstanding balance has been paid in full. If payment is not received within five (5) calendar days of the invoice due date, the account may be placed into collections status. At that time, an additional $100 administrative service fee and a 4.7% payment processing fee will be added to the outstanding balance. Dream Beauty Home Health Care reserves the right to pursue all available legal remedies to recover unpaid amounts, including collection costs, court costs, attorney’s fees, and any other expenses permitted by applicable law. Late Cancellation PolicyDream Beauty Home Health Care maintains a strict scheduling policy to protect the time, availability, and compensation of our nurses, physicians, and healthcare professionals. All appointment cancellations or requests to reschedule must be submitted at least two (2) hours prior to the scheduled appointment time. Cancellations made less than two (2) hours before the scheduled appointment may be subject to a late cancellation fee equal to up to two (2) hours of scheduled service charges. No-Show Policy If a provider arrives at the scheduled appointment location and the client, patient, responsible party, or authorized representative fails to answer, is unavailable, denies access, or otherwise fails to attend the appointment without prior notice, the appointment will be considered a No-Show. In such cases, the client will be responsible for: • The full scheduled service amount. • Applicable travel expenses. • Standard mileage reimbursement. • Fuel reimbursement based on current fuel rates, up to $7.15 per gallon. • Any additional expenses incurred by Dream Beauty Home Health Care in connection with the missed appointmentRepeated late cancellations, no-shows, or non-payment may result in suspension or permanent termination of services at the sole discretion of Dream Beauty Home Health Care. AcknowledgmentI acknowledge that I have read, understand, and agree to the Payment, Cancellation, and No-Show Policy of Dream Beauty Home Health Care. Client Name: ______________________________________. Client Signature: __________________________________. Date: _____________________________________________Representative Signature: ___________________________ Date: _____________________________________________ Agreement Payment is due according to the service agreement. Late payments may result in suspension or cancellation of services. A minimum of 2 hours’ notice is required for cancellations. No-shows and missed visits without proper notice may be charged the full scheduled service amount, including applicable travel, mileage, and fuel expenses. Client Initials: _________
Client Initials above
Consent for ServicesI authorize Dream Beauty Home Health Care to provide the requested home care services and understand that services may be adjusted based on assessment and client needs. Dream Beauty Home Health Care. Client Name: ______________________________. Client Signature: ___________________________ Date: _____________________________________ Agency RepresentativeRepresentative Name: _______________________. Signature: _________________________________ Date: _____________________________________ Client Name: ______________________________________. Client Signature: __________________________________. Date: _____________________________________________Representative Signature: ___________________________ Date: _____________________________________________
Client Initials above
Dream Beauty Home Health CarePhone: (833) 492-6473

Website: dreambeautyhomehealthcare.square.site
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Financial Agreement

Payment, Cancellation Late Payment PolicyPayment
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Dream Beauty Home Health Care

Payment, Cancellation Policy, & Late Payments

Dream Beauty Home Health CarePhone: (833) 492-6473

Financial Agreement