Apex New England Physical Therapy PRACTICE POLICIES
APPOINTMENTS AND CANCELLATIONS
Please remember to cancel or reschedule at least 24 hours in advance. You will be responsible for the entire fee of $25 if cancellation is less than 24 hours.
The standard meeting time for a Physical Therapy session is 60 minutes. It is up to you, however, to determine the length of time of your sessions. Requests to change the 60 minute session need to be discussed with the healthcare provider in order for time to be scheduled in advance.
A $25 service charge will be charged for any checks returned for any reason for special handling.
Cancellations and re-scheduled treatment sessions will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a treatment session, you may lose some of that session time.
TELEPHONE ACCESSIBILITY
If you need to contact me between sessions, please text me or leave a message on my voicemail (413)264-6412. If I am with another patient, I might not be immediately available; however, I will return your call within 24 hours. Please note that Face- to-face sessions are highly preferable to phone or telehealth sessions. However, in the event that you are out of town, sick or need additional support, telehealth sessions are available. If a true emergency situation arises, please call 911 or any local emergency room.
ELECTRONIC COMMUNICATION
I cannot ensure complete anonymity of any form of communication through electronic media, including text messages. I can only guarantee confidentiality on my part. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, I will do so. While I may try to return messages in a timely manner, I cannot guarantee immediate response. Thus its is imperative that you do not use these methods of communication to request
assistance in case of emergencies.
MINORS
If you are a minor, your parents may be legally entitled to some information about your treatment. I will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately
kept confidential.
TERMINATION
Ending relationships can be difficult. Therefore, it is important to have a termination process in order to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. I may terminate treatment after appropriate discussion with you and if I determine that the treatment is not being effectively used or if you are in default on payment. I will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If treatment is terminated for any reason or you request another provider, I will provide you with a list of qualified Physical Therapists to treat you. You may also choose someone on your own or from another referral source.
CONCIERGE FEE DISCLOSURE
Transparent pricing with quality care, provided in the comfort of your home:
Evaluation
60 min visit: diagnosis + treatment – $150
Treatment Session
60 min treatment visit – $130
Telehealth
30 min online consultation + treatment – $100
______ I have read the above codes and fees and understand the cost of my care at Apex New England Physical Therapy.
______ I understand that I am responsible for payment of all deductibles, co-payments and amounts not paid by the insurance company related to my care.
______ I understand that if I have a balance for medical services not paid, I will make a minimum payment of $50.00 each month or 25% of the outstanding balance, whichever is greater, unless other payment arrangements have been made.
______ If the balance owed is not paid in a timely and monthly fashion, I acknowledge that I will be required to also pay all collections fees (25% additional cost above my balance), all court fees and all attorney fees in the collection of my account.
______ I further understand that if my treatment is associated with a personal injury or accident claim, all medical bills will be paid at 100% of the above fee schedule regardless of the outcome of my case.
______ I understand that Apex New England Physical Therapy reserves the right to charge for missed appointments and cancellations without 24 hours’ notice.
______ I understand that if a check or debit (Zelle, Venmo, Cashapp, Apple Pay etc…) is returned for insufficient funds, I will be charged a $25.00 service charge.
______ Furthermore, I understand and authorize credit card transactions to balance my account. [No credit card charges will be rendered without a diligent effort to make contact and establish payment arrangements.]
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Patient’s name
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Signature Date