1. Accounts
Accounts are to be settled on the day of service, unless arranged prior. You are welcome to pre-pay for appointments or future services.

2. Late Cancellations / Missed Appointments
As a courtesy, we request notice of cancellation 24 hours in advance of your appointment. Patients who do not give 24 hours notice for a missed appointment may be charged a fee of $30. After two missed appointments (ie. third missed appointment) you may be charged the entire time reserved for you on the schedule. Exceptions are made for emergency / serious cases.

3. Non-payment
If your account is over 90 days past due, you will receive a letter stating that you have 30 days to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. If your account remains unpaid, it may be referred to a collection agency and charged a processing fee of $75, and you may be discharged from this practice. There is a $35 fee for returned cheques to cover bank fees.

4. Insurance
You are financially responsible for all charges, with payment expected from you within 7 days of statement notification. Knowing your health insurance coverage is your responsibility and you should contact your insurer with questions about your coverage before your visit. It is your responsibility to follow up with any claim with your insurer.

5. Prescriptions
Payment in full is expected at the time of purchase of any items. Returns cannot be accepted once the safety seal has been broken. There is no requirement to purchase recommended products from the clinic. There are several stores locally that may carry similar products. An online account can be set up for you to receive electronic prescriptions and purchase products online.

6. Release of Information
In some cases it is necessary to release some or all of your information to a third party. This may be another medical practitioner (referral), pathology company (accompanying request) or your referring practitioner (report). Your information will never to be released to any party not directly involved in your care. In addition, the practice may seek information from your other care providers, including pathology or other results, previous reports or letters, and/or any other information relevant to your treatment.

Authorisation:
o I have read the above and agree to conditions of this practice.
o I agree to pay for all services rendered.
o I authorise the release of my medical or other information necessary as explained above.
o This form has been completed electronically - by writing my name below, I am effectively signing this form.
o As not all third parties accept electronic signatures, I understand I may be asked to sign a hard copy version upon attendance at my appointment.