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LATE CANCELLATIONS AND NO-SHOWS

If you need to cancel an appointment, please provide us with at least a 24 hour notice.  We reserve the right to charge a fee of $35 for no-shows and appointments cancelled within 24 hours. If a patient cancels / no-shows an excessive number of scheduled appointments, physical therapy services will be discontinued and their doctor will be notified.

 

TIMELINESS

We value your time and don’t want to keep you waiting. Occasionally we are delayed by an unexpected event with another patient, but please be assured that the quality of your appointment will not suffer. If you arrive late, your treatment will end at its scheduled time in order not to keep the next person waiting.

 

FINANCIAL POLICIES

As a courtesy to our patients, we are happy to bill your primary and secondary insurance companies.  We do not bill third payors.   If there are problems with payment from any insurer, it will be the responsibility of the patient to resolve these issues.  If your insurance company denies payment after you have received treatment, you are responsible for the balance.  It is your responsibility as the patient to know your insurance benefits in regards to deductibles and/or copayments. If your insurance plan does not cover physical therapy treatments, we will work with you toward a resolution to enable you to receive the treatment that you need.  It is Active Life Physical Therapy’s policy that everyone should have access to care. 

CO-PAYMENTS:  If your insurance plan requires a co-payment, it is payable at the time of service.

 If you do not have insurance coverage, payment is expected at the time of service, or upon receipt of your bill, unless you make other payment arrangements. Please let us know if you need to arrange a payment plan that allows you to pay off your balance in monthly installments.  We understand that financial problems do arise, and we are very willing to work out a payment schedule with you.  If you do not contact us, and your account is seriously past due, it may be turned over to a collection agency.

If you have any questions about the financial policies, or need assistance with your bill or your insurance, please call our office at 360-437-2444.

 

Please advise us as soon as possible of any changes that may affect your billing, i.e., address, employment, new injury, or insurance changes.

 

                                                    PATIENT CONSENT AND RELEASE 

By submitting the below Telehealth consent form, you are agreeing to the following:

 

  • I understand that I am financially responsible for all charges and services rendered regardless of litigation, insurance reimbursement, or pending claims. I understand that the parent/guardian presenting with a minor will be responsible for payment.

 

  • I authorize Active Life Physical Therapy, LLC to release any necessary information requested by my insurance carrier and authorize payment directly to Active Life Physical Therapy, LLC for any benefits available under my insurance plan.

 

  • I hereby consent to treatment by Active Life Physical Therapy, LLC. via telehealth platform Doxy.me

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  • I understand that reasonable and appropriate efforts have been made to eliminate any conô€ƒ¨fidential risks associated with telehealth consultation, and all existing conô€ƒ¨fidentiality protections under state and federal law apply to information disclosed during this telehealth consultation.

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  • I acknowledge that I have read and understand the cancellation, no-show, timeliness and financial polices stated above.

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  • I consent to receive written communication via email and US mail from Active Life Physical Therapy, LLC

TELEHEALTH CONSENT FORM

By submitting this form it will act as your digital signature and agreement to the telehealth patient consent and release.

I have read and understand the above policies.

Thanks for submitting!

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