Interim Health Update Form

For Existing Clients Between Visits

If your appointment is virtual, Please click link below for directions

 

 

CLIENT INTAKE FORM – POLICIES & AGREEMENT

Package, Boost & Communication Policies

By purchasing services and completing this intake form, I acknowledge and agree to the following:

Package Use

  • 3-visit, 5-visit, and 12-visit packages must be used at a rate of one visit per month

  • Visits not used within the monthly timeframe are forfeited

  • Unused visits do not roll over

Boost Appointments

  • Boost appointments must be used within 6 months of purchase

  • Unused Boost appointments expire after 6 months and do not roll over

Email Communication

  • Email support is available only between scheduled monthly visits

  • Email communication is limited to brief clarification related to the current plan

  • New concerns, ongoing issues, or detailed questions require a scheduled appointment

Boost Appointment Email Support

  • Email support following a Boost appointment is available for up to 14 days

  • Limited to brief clarification related to the Boost visit

  • After this period, all questions require a scheduled appointment or active package

I understand these policies and agree to abide by them in order to receive care.

☐ I have read and agree to the above policies