By signing below I acknowledge that regardless of any insurance status, I am responsible for the balance due on this account for any and all professional services rendered. I understand payment is expected at the time of treatment unless prior arrangements have been made with the office.
I understand that when an appointment is booked, it is considered reserved and if I do not provide at least one business days notice to reschedule, I will be responsible for a missed appointment fee between $50-200 depending on the length of my appointment. Repeated no-shows will result in me having to make a deposit in order to book an appointment.