Office Information and Policy
It is our goal to make everyone’s visit(s) here a wonderful experience. Our caring doctors and staff are committed to helping you achieve your goals and provide an atmosphere conducive to our integrative philosophy of addressing the whole individual (mind, body, and spirit). To aid in our commitment it is important that patients, clients, students and attendees cooperate with the following office policies. Thank You!
Payment
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.
Document and Clerical Requests
There will be a clerical charge for any invoices, data, forms, notes etc. provided to the client/patient or their agent. The charge is $15.00 for the first page of any document and $5.00 for each additional page. If it is necessary for doctors or staff to generate a new document that charge will based on the practitioner’s average hourly billable rate. (Min of 1 hour charge, payable in advance). If a BodySmart Wellness doctor or staff is asked by the patient to contact any other party (insurance companies, other providers, lawyers, family members etc. and BodySmart Wellness agrees to do so, billing will be as follows: Provider calls are based on the practitioner’s average hourly billable rate. (Min of 1 hour charge, payable in advance). Staff calls on the patients behalf will be billed at $30.00 per hour (Minimum of 1 hour billable). An invoice or receipt given for payment at the time of payment, of course is FREE.
Late, Missed and/or Changing Your Appointment
We attempt to see our patients on time. If someone is late for his or her appointment, the next patient, person is forced to wait past his or her scheduled time, therefore, 15 minutes late or more may be considered a missed appointment at the discretion of the provider. Save your appointment card. It is the only verification of your appointment time that will be accepted in the event of conflicting recollection of the appointment day and time. For any appointment cancelled before 8:00 AM on the day of the scheduled appointment there will be charged $50.00 late cancellation fee. For any cancellations after 8:00 AM on the day of the scheduled appointment, the full fee for the visit will be charged. Your time is set aside specifically for you. As well, it is normally impossible for us to fill a cancellation on short notice so… please be on time for your appointment or you may be charged for the missed appointment (or lose a session if already paid for). We require 24 hours notice to change an appointment.
Refund Policy
All sales (programs, appointments, services, sessions, workshop, merchandise) are final. We will gladly replace any defective product with one identical or as close to identical as possible if it is brought to our attention within 48 hours. Unused portions of items such as supplements must be returned in the original container to receive a replacement or office credit at BodySmart Wellness’s discretion. Since success is a joint effort between the provider and the patient, client, student, or customer, we offer no guarantees stated or implied. We will do our part. If you follow instructions and do your part, success is the likely outcome.
Misc.
No unattended children under the age of 16 years old can be left unattended in the reception area or the outside halls. This is for liability reasons and as a courtesy to other patients, clients and students. Patients may not bring another person to share or piggy-back with their appointment. Anyone wishing services must schedule their own appointment.
As a courtesy to other patients clients, and students, and to maintain the serene atmosphere that we of striving for, absolutely no cell phone use is permitted in the office. If you must make or take a call, please step into the hallway.
Patient Specific Medication and Other – Order Policy
I (the patient or customer) agree to be responsible for cost of medications, supplements or any other item(s), as well as any related clerical, shipping, or other expense(s) incurred by BodySmart Wellness LLC., for any item(s) ordered on my behalf. I acknowledge that I am over 18 years of age and have the authority to accept responsibility for the cost of such orders. I agree that my making an appointment for any treatment or procedure requiring that medications (or any other supplies) be ordered on my behalf, is also verification of my agreement to be responsible for the cost of the item(s).
No Order Cancellation: I understand and agree to the following: Shipments are usually ordered the same day as a patient or customer orders and/or agrees to treatment. Since the medications and supplies often ship the same day as ordered, once ordered by BodySmart Wellness LLC./Dr. Kimelheim, or any office representative, orders may not be cancelled once placed. If for some reason BodySmart Wellness LLC and/or Dr. Kimelheim, as a special courtesy, and at the sole discretion of BodySmart Wellness LLC and/or Dr. Kimelheim, agree to allow the cancelation of an order, I (the patient or customer) agree to be responsible for reasonable shipping and handling charges as well as a fee (fee not less than $50.00 and not more than $150.00) for clerical, postage, restocking charges and other expense to BodySmart Wellness LLC and/or Dr. Kimelheim. If this occurs, I understand that the courtesy is a one-time courtesy and that this document will remain in full affect for any other orders. I further agree that in the event that I fail to make payment as indicated that I will be responsible for any and all collection and collection related fees and any legal fees incurred by BodySmart Wellness LLC and/or Dr. Kimelheim and/or Dr. Holder.
Sterility: I understand and agree to the following: In cases where maintaining sterility is an issue, I the patient and/or customer agree to be responsible for the cost of the medications, products and/or other parts of any order, as well and any related shipping and handling charges, if sterility is compromised while the medication(s) etc. are in my (patient/customer) possession. I understand that I must bring any shipment of medications (or other items) ordered for me and shipped to me to the BodySmart Wellness LLC and/or Dr. Kimelheim and/or Dr. Holder office unopened and in the condition shipped.
I (The Patient and/or customer) understand that BodySmart Wellness LLC and/or Dr. Kimelheim, Dr. Holder or any office staff member will ONLY discuss matters concerning my medications or my treatment or any other matter with me, the patient/customer. I further understand and agree that BodySmart Wellness LLC and/or Dr. Kimelheim, Dr. Holder or any office staff member will not discuss my medications and/or treatment with spouses, other family members, other offices, or any other person or entity without prior written consent provided via the BodySmart Wellness release form. A copy of this form can be requested from BodySmart Wellness LLC and/or Dr. Kimelheim. I acknowledge that I have the authority to have BodySmart Wellness LLC and/or Dr. Kimelheim place orders on my behalf and I accept full responsibility for payment as outlined above.
For Office Use Only:
Special Order Info:
Description
Non Refundable Deposit or Fee Or Cost To Patient/Customer:
Deposit Required Prior To Order Being Placed: Yes No
(The above amount will be billed to your credit card when the order is placed)
Hold Harmless
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. Holder, Dr. Kimelheim 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