Below is a summary of of my terms and policies. You will find a complete version of the policies here. Please read them completely before agreeing to them in your intake form.
NOTICE OF PRVACY PRACTICES & CONSENT FOR CARE
I keep a record of the health care services I provide you. You may ask to see and copy that record. You may also ask to correct that record. I will not disclose your record to others unless you direct me to do so or unless the law authorizes or compels me to do so.
The Notice of Privacy Practices describes in more detail how your health information may be used and disclosed, and how you can access your information.
CLIENT EMAIL AND TEXT MESSAGE INFORMED CONSENT
The Client Email and Text Message Informed Consent You may give permission to Nectar Massage & Bodywork and to Alexandra Sollek, LMP to communicate with you by email and text message (also known as SMS). This form provides information about the risks of these forms of communication, guidelines for email/text communication, and how we use email/text communication. It also will be used to document your consent for communication with you by email and text message.
The Informed Consent for Care describes the range of services offered and what each service entails.
FINANCIAL & CANCELLATION POLICY
Payment is due in full at the time of service. Fee for treatment will be listed on website for self pay. If using insurance, you will be informed of fees as soon as they are known for your plan. You agree to pay all fees for such service. In the event that your account is over due and costs associated with services provided for care have not been paid, you will pay any costs and fees associated with fulfilling that balance. You will be charged a $35 cancellation fee for missed appointments if 24-hour notice is not given unless approved by the practitioner.
If using insurance or PIP to cover treatments, you will verify that you have coverage with your policy provider and give the correct information to be used for billing. You authorize the release of your medical information to their insurance carrier regarding any treatment you may receive. I hereby instruct my insurance carrier to remit payment to Alexandra Sollek, LMP for services rendered. I understand that I am responsible for paying for services in the event that my insurance company fails to do so.