Thank you very much for allowing me to assist you in taking control of your health and improving your quality of life.
Self Pay (not insurance): Payment in full is collected at time of service by cash, check, or credit card.
Medical Insurance: Any deductible payment is due at the time of service. Your insurance company will be billed for the balance, if you have coverage for massage treatment and it has not run out. If the insurance company denies your claim, you are responsible for the full remaining balance, as agreed to in the Financial Agreement document signed by you.
Personal Injury/PIP (auto): You will need to contact your automobile insurance company to let them know about your care and to request that forms be sent to initiate a claim. Please contact your physician or chiropractor to obtain a prescription for massage, and have the prescription faxed to this office. You are still responsible for your bill, but you will not be required to pay at the time of service if your insurance company establishes payment. No reduction of payment will be accepted.
Third-party Auto: Not accepted at this time.
Workers Comp/L&I: A claim will be filed granted a valid L&I claim number and prescription are obtained prior to treatment. It is understood and agreed that, at any time L&I makes a determination to deny your claim, even after treatment has been completed and the account has been paid in full by L&I, you agree to reimburse Jen Lindsay LMT in full for the total “charge back” from L&I within 30 days of notification of “charge back” from Jen Lindsay LMP or L&I.
Court Fees: If, for any reason, there is an unpaid balance on your account that forces Jen Lindsay LMT to take legal action against you, you agree to pay all court costs, filing fees, attorney fees, and balances owed. You also agree to pay an additional $325.00 each time Jen Lindsay LMT has to go to court concerning you and your account.
Illness: If you are ill on the day of your scheduled appointment, please call to reschedule. You will not be massaged if you have a fever, contagious or mysterious skin rash, or other contagious illness, such as the flu.
Cancellation Policy: The appointment time is set aside for you. If you cannot keep your appointment, we require 24 hour notice to avoid being charged for the visit. Any cancellation received less than 24 hours in advance, or if you do not show up for a scheduled appointment, will result in you personally being charged the full reimbursable amount for that appointment, with a minimum charge of $65.00. A cancellation due to an emergency (e.g., illness) may or may not result in a charge, at my discretion.
Showing up Late: You will only be given the remainder of the scheduled appointment time. You will be required to pay for the full time allotted for your massage. We will not be able to add time to the end of your scheduled appointment time to make up for the time lost for being late. If you show up 15 minutes late or more, your appointment will be cancelled, and you will be responsible for paying the full value of your appointment, which is not billable to your insurance company.
Sexual Misconduct: Sexual misconduct will not be tolerated. You understand that any illicit or sexually aggressive remarks, advances, or gestures will result in the immediate termination of the session, and you will be liable for full payment of the scheduled appointment.