Private Patient Form

Medicare Patient Form

Office Policies

 

• A valid credit card is required to secure appointment reservations and will be held on-file for future visits. Visa and Mastercard are accepted.

 

•  An administrative Annual Service Fee of $250 will be charged to your card on file, unless otherwise noted, before booking an appointment each calendar year.

 

• Patients must provide a 48-hour advance notification to cancel or reschedule appointments. If less than 48-hours notice is given, the patient will be held accountable for the full amount of the service charged to the credit card on file.

 

• Your appointment time is set aside solely for you, therefore we appreciate you being on-time. Late arrivals will result in abbreviated treatment time.

 

• For private patients, payment is required at the time services are rendered.

 

• New Patients are required to fill out required forms prior to their first visit.  Please visit our Patient Forms page for more information.  If you are unable to do so, please arrive 15-20 minutes early for your first appointment to complete the registration process.

 

• In order to be sensitive to the needs of our patients, pets are not permitted on the premises.

 

• To maintain a peaceful, healing environment, cellular phone use is prohibited in our wellness centers.

 

• From The Heart Physical Therapy reserves the right to refuse service to anyone at any time for any reason.