Welcome to Rehabilitation Chiropractic Care, P.C.
“In The Business of Health”
Dear New or Returning Patient:
Welcome to the health care facility of Rehabilitation Chiropractic Care P.C. This facility is primarily interested in teaching the benefits of receiving preventative chiropractic care, proper nutrition and rehabilitative exercise to our patients. Our licensed professional staff will treat you with modern treatment modes.
Terms of Agreement:
Patient understands and acknowledges the following criteria:
Consent for Massage Treatment
– I hereby consent to the performance of Massage and rehabilitative exercise on me.
– I hereby give Rehabilitation Chiropractic Care P.C. or staffs consent to treat myself/my minor child. I am welcome to observe the treatments.
– I acknowledge that all information is factual and complete After reading and filling out my patient intake forms, I state that all of the information given is accurate and reflects my current health status. To facilitate safe, effective massage care, I understand that my records must be up-to-date. I am responsible in notifying the doctor and staff on any changes to my healthcare to include but not limited to: illness, surgeries, accidents, or other injuries.
– I understand that payments (including cash, insurance deductibles, co-insurance and co-payments) are due at time of service, unless otherwise agreed to in writing. The patient is responsible for their bills. I further understand that interest and/or late payment fees will be charged to delinquent accounts. Payment is due upon receipt on invoice. Payment arrangements are available upon advanced request.
Appointment Policies and Fees
– I understand that I am expected to be on time for my appointment and if I am late I will be asked to wait or reschedule for a later time in the day if possible. I understand that I must notify the office 24 hours in advanced in order to cancel my appointment and if I fail to do so, my account will be charged a late fee which is posted in the office.