Quantum Vitality Office Policies Twitter Welcome! It is with great pleasure that we provide the services for you here at Quantum Vitality. We offer a variety of services, and tailor your treatment plan to you and your specific needs. I will separately provide some forms for you to complete, which will help me to begin developing your individualized treatment plan. Our Office Policies The following are some important policies. Please check each box to indicate that you understand and agree to the following office policies. (All boxes must be checked prior to submitting this form). Payment, Fees, Cancellation and Refunds Policies: * Fees are due at the time of service unless prior arrangements have been made. We accept cash, checks and PayPal (credit card may be used with PayPal, for a fee to PayPal). We do not provide insurance billing or insurance-related services (diagnosis, superbills and the like). We require at least 24 hours to cancel or reschedule appointments. You may receive an appointment reminder 1 to 2 days before your visit; however, the responsibility is yours. Late cancellations and no-shows are billed in full. If your check is returned for any reason, you will incur an administrative fee of $25. There are no refunds for products. Please make your choices carefully. There are no refunds for packages of sessions, after your session: - During the first 20-30 minutes of the first session, Dr. Moore will give you the opportunity to decide whether you want to continue with this work. If you choose to discontinue the session, we will end there, with no charge. - At the end of the first session, you will be given the opportunity to either pay for the single session, or purchase a package with no refunds. Please check all boxes to indicate your understanding and agreement. Please print your name to indicate your full understanding and agreement before submitting this form. Your First and Last Name * Your email * Date * Thank you!
