Whether paying with cash, check or credit card it is required that we have a valid credit card on file. If the credit card that you are using is that of someone else, their information (address, phone number, email, etc.) must also be included on our credit card form. The patient, client or customer in signing this form acknowledges that any unpaid balances or other money owed may be charged to this card if their account is not current. This includes charges for missed appointments. Payment for services are due either at the time services are provided or prior to that time depending on the program you have selected unless other arrangements are approved in advance by the office management in writing. Since we set aside 2 hours for most initial appointments, all new patient's cards will be charged prior to that initial visit so that payment has posted by the date of that appointment. Excluding calls made for the sole purpose of scheduling an appointment(s) telephone calls/consultations lasting more than 5 minutes are billed as an appointment. Please make an appointment to discuss your case, review labs etc. (Provider's time and knowledge are their stock and trade). Note: There is a $50.00 charge for checks returned un-payable for any reason or for credit card charges denied. This document authorizes BodySmart Wellness to bill your credit card.
Signer accepts responsibility for payment of fees. Client/Patient holds harmless, indemnifies and agrees for his/her self and his/her heirs and assignees not to sue BodySmart Wellness LLC., Dr. Philip Holder, Dr. Marie Holder and any staff or associates arising out of his/her participation & affirms that he/she is participating of his/her own free will. The patient/client/student/customer will be held responsible for any reasonable legal fees incurred by the provider in the collection of money owed or any damage caused to the provider financial or otherwise. If any part of this agreement is deemed unenforceable all other parts of this agreement remain in full effect.
No pets are allowed in the office building. THIS IS A TOBACCO FREE OFFICE
Consultation Payment Policy
A fully refundable fee of $50 is billed for all half-hour consultations. The perspective patient/student/customer, will have the option to either: (1) Receive a refund of the $50 consultation fee, or (2) He or she may apply the $50 fee to any program selected.
To Qualify For Your Refund: Consultation Refunds are subject to the following terms:
1. The perspective patient/student/customer, must attend the consultation, arriving at the BodySmart Wellness/Masters Center Offices at the agreed to appointment time.
2. Standard BodySmart Wellness/Masters-Center Consultation Registration form(s) must be fully completed 48 hours prior to the appointment, unless other arrangements have been made in writing, in advance, regarding completion of the form(s).
3. The credit card of the patient/student/customer, will be charged the $50.00 fee the day the appointment is made. (We accept MasterCard and Visa Only)
4. If the perspective patient/student/customer needs to change his or her appointment time and/or date, prior notice of 24 hours is required. This time slot was specifically set aside for the perspective patient/student/customer and it is usually impossible for us to fill a slot at the last moment.
5. Out of courtesy for the person who's appointment follows the perspective patient/student/customer's consultation, it is important that the perspective patient/student/customer, be on time for his or her appointment. Lateness of 15 minutes or more may be considered a missed appointment at the discretion of BodySmart Wellness/Masters-Center.
6. If a perspective patient/student/customer schedules an appointment and fails to attend their scheduled consultation, the $50.00 fee will not be refunded.
It's just that simple. Your consultation costs you nothing after refund or credit!