Financial

♦ If you cannot afford my regular fee I may adjust your fee based upon determination of financial hardship. Proper documentation will be required. Please discuss your situation when you contact my office for your first appointment.

♦ I accept payment by credit/debit card (except American Express) or FSA card and require a valid card be kept on file. If a valid credit/debit/FSA card is not on file at the time of your appointment, your appointment will need to be rescheduled.

♦ Payment of the portion of my fee you are responsible for per your insurance plan, or the fee we have agreed upon, is due at the time of your appointment unless prior arrangements have been made.

♦ If an appointment is missed or cancelled with less than twenty-four hours’ notice you will be solely responsible for paying my fee according to my Information, Notice of Disclosure, and Practice Policies or according to the rules of your insurance plan.

♦ All other policies and terms as set out in my Information, Notice of Disclosure, and Practice Policies, any Fee Agreement signed by both parties, and any other documentation.