APPOINTMENT POLICY
If you are unable to keep an appointment for any reason, please call immediately to notify the office.
This office reserves the right to charge $30 for missed or cancelled appointments without a 24-hour notice.
E-MAIL POLICY
Unsecure email communication containing sensitive health information can be sent between Optima and you. If this form is sign by you, and at a future date you request information to be emailed to you, then unsecure email communication about your medical care and treatment may be used to transmit information.
X-RAY POLICY
The x-rays that are taken are the property of Optima Health & Vitality Center. Release for purposes of review can be arranged at your request.
WORKMEN’S COMP POLICY
Our office does accept workmen comp cases. However, it is not considered work comp until we have all insurance information, a claim number on file and liability is accepted. Until that time, all charges are the patient’s responsibility and are collected in full at time of service. Any denied workers comp claims will become patient responsibility.
PERSONAL INJURY POLICY
Our office does accept personal injury cases. Optima Health will be happy to submit all services to your insurance company. However, all charges are the patient’s responsibility and are collected in full at time of service unless other arrangements are made with the business office.
TEXTING
At your request, communicating via text through an unsecured network including images of lab work results is permitted if this form is signed.
FINANCIAL POLICIES
FINANCIAL AGREEMENT-NO INSURANCE
In consideration for the services rendered to me by Optima Health & Vitality Center, I agree to pay for all charges incurred on my behalf and my dependents behalf at time services are received.
FINANCIAL AGREEMENT-INSURANCE
For all in network patients submitting services to insurance, Optima Health & Vitality Center will call to verify benefits, and will submit billable charges to your insurance company.
Verification of benefits is not a guarantee of payment. All deductibles, co-pays and co-insurances are patient responsibility and may be collected at the time of service.
I understand it is my obligation to pay any and all balances deemed patient responsibility within 30 days of receipt of statement.
LAB WORK/BLOOD WORK POLICY
All lab and blood draw charges will be collected in full at time of service. Lab services are considered a cash service and will not be submitted to insurance.
NSF CHECKS / PAST DUE ACCOUNTS
There is a $30 NSF fee charged on all returned checks. Accounts over 90 days past due may be turned over to collections.
FOR YOUR CONVENIENCE WE OFFER MANY OPTIONS FOR PAYMENT, INCLUDING:
Cash / Personal Check / Visa / MasterCard / Discover / American Express / Care Credit