Happy Head Chiropractic Wellness Plan Cancelation Form
By submitting this form, you agree to all the terms and conditions of the Wellness Plan Terms of Service and Cancelation Policy below

Cancelation requests are effective immediately
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Wellness Plan Terms of Service
- Wellness Plans & Treatment are unique to your health goals and are non-transferrable and may not be shared with family or friends
- Wellness Plans require a Credit/Debit card to be stored within the Patient's Portal Account for a RECURRING monthly charge for the plan to remain active.
- Wellness Plans may be canceled at any time by providing written notice to billing@happyheadchiropractic.com and through the cancelation form
- If the credit/debit card charge is declined for any reason, the plan will automatically be cancelled and grandfathered pricing discontinued.
- Upon cancelling your wellness plan, unused visits are immediately voided and cannot be redeemed.
- No shows / Late cancellation within the 24 hr period are deducted from your available visits
- Unused visits do not roll over

WELLNESS CANCELATION POLICY
Prices are subject to change.

Happy Head Chiropractic reserves the right to change prices without notice. In such cases, Happy Head Chiropractic will honor any existing active wellness plans at the old price structure purchased prior to June 1, 2021 however roll over visits will no longer be offered.

If the Grandfathered Wellness Plan is canceled for any reason, the old pricing structure will no longer be honored and wellness plans will only be offered at the updated price model.

If the Credit/Debit card on file is declined for any reason, Happy Head Chiropractic grants a 48-hour grace period for any unresolved billing errors. The Clinic will attempt a verbal and written notification directly to the patient before the plan is automatically canceled after the 48-hour grace period.

Wellness Plans may not be "paused" or put on hold. You can cancel your wellness plan and sign up at any time once you return. Wellness Plan pricings are subject to change at any time, and once you sign up again it will be at the updated price.
Today's Date *
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First Name *
Last Name *
Phone Number *
Reason for Cancelation *
By submitting this form, you fully understand and agree to the Wellness Plan Terms of Service and Cancelation Policy and that cancelation will be effective IMMEDIATELY. Refund requests that are in clear violation of the Terms of Service and Cancelation Policy will not be honored. *
A copy of your responses will be emailed to the address you provided.
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