Patient-Centered Care, Informed Consent, and Financial Policy
Thank you for choosing us as your dedicated healthcare provider. We deeply value the trust you place in us for your health and wellness needs. Our commitment is to provide exceptional care, and we have established the following policies to ensure your experience with us is positive, respectful, and focused on your well-being.
Financial Policy
Symbiotic Relationship: We view our relationship with you as symbiotic. Our policies are designed to keep our doors open, ensuring we can continue to serve your health needs effectively.
Thank You: Quantum Cash can be earned by referring others to our practice. Quantum Cash can be used for future visits or supplement purchases.
Membership Payments: Payments for memberships are prepaid or involve monthly withdrawals.
Non-member payments: Payments are due before the visit, non-refundable, and non-transferable with a 48-business-hour notice. Charges for your visit will be run on your card-on-file within the 48 hour period prior to your scheduled appointment.
Guarantee and Refund: Our guarantee is that you may receive a refund for prepay programs for thirty days after you make your commitment. There is no cancellation after 30 days for prepayment programs. Service fees are not transferable to products. If an associate practitioner leaves NHW, their patients are patients of NHW and there are no refunds given, and care is transferred to another practitioner within the practice. No exceptions to this policy. Clients who move will have appointments shifted to telehealth.
Supplement Policy: We understand that purchasing supplements are necessary to support your health goals. To support your need for supplements, your Functional Medicine and QRT visit fees have been lowered substantially, with the expectation that you will purchase your supplements from NHW. This allows us to further support you while keeping our doors open in our symbiotic relationship. You are free to purchase your supplements elsewhere. As such, your visit fees will be assessed at the standard rate which will be incurred at the time of your visit. This fee is typically double your prepaid membership visit amount or triple time-of visit appointments.
Supplements are available for purchase from NHW online or in the office. Please let us know a week in advance of needing supplements for pick-up. By doing so, we will be able to order what you need and have them available to you at the office. If supplements are on backorder, we are happy to find an alternative for you.
Insurance Information: While we do not file for insurance, upon request we will provide a paid Superbill for potential reimbursement. Please be aware that some, and perhaps all, of the services provided may be “non-covered” services. You are responsible for payment in full regardless of any insurance company’s arbitrary determination of usual and customary rates. Additional charges may apply for specific insurance-related services as they may incur additional staffing needs.
Payment Options: Payment for appointments is due in full prior to or at time of scheduling your visit. We accept HSA, FSA, MasterCard, Visa, Discover, cash, and checks. Payment with cash or check must be communicated prior to your visit.
Appointment Cancellation Policy:
Because we offer specialized services, we only see a limited number of patients per day. When clients do not show up or cancel for non-emergency reasons, it takes valuable time away from those clients on our waiting list. With adequate notice of cancellation, we are often able to schedule those clients on our waiting list.
Cancellation Notice:
- New patient appointments require 1 weeks' notice.
- Established patient appointments require two business days' notice. Rescheduling within this time frame is considered a cancellation.
Cancellation Charges: Cancellations within the stipulated time or "no-shows" incur the charge of the visit up to and not exceeding $497. Rescheduling at the time of cancellation provides a one-time 50% credit for future appointments. Packages or prepay losses are incurred for partial visits.
Monday Appointments: Monday appointments must be canceled by the preceding Wednesday to avoid charges.
Emergency Cancellations: Cancellations for emergency reasons are excluded from the policy and require rescheduling for a future appointment at time of cancellation. A habit of emergency cancellations may result in being released from care.
Support and Communications
Fragrance Policy: To accommodate sensitivities, please avoid fragrances, including essential oils, when coming to in-person appointments.
Communications: Please utilize Healthie for private messages (HIPAA) or contact the office via phone or text.
Questions and Answers: Clients should fully understand the consent form, and signing indicates acknowledgment and agreement.
By signing below, I agree to the above policies for my care at NHW.
INFORMED CONSENT
FUNCTIONAL HEALTH AND CHIROPRACTIC CARE: Dr. Juul is a doctor of chiropractic. Doctors of chiropractic practicing in a functional health model view health as a continuum from optimal health to hidden imbalances to disease. Rather than treating disease (e.g. cancer, hypothyroid, or multiple sclerosis), we address underlying metabolic, physiologic, and functional imbalances, intervening at root causes. One effect may be the ability to reduce or eliminate the need for medications, which must be done by your prescribing provider. As doctors of chiropractic, we do not prescribe drugs or perform surgery. Therefore all changes to prescription medications must be made by your prescribing provider.
Because we are often dealing with challenging disorders in which the traditional standard of care has failed to resolve the problem, we utilize nontraditional treatment strategies. We attempt to find new, effective, and creative ways to arrest the progression of acute/chronic disease states, reverse acute/chronic symptoms, and to optimize health through restorative and preventive practices. These may include but are not limited to chiropractic adjustments, dietary recommendations, whole food supplements, nutraceuticals, herbs, homeopathic, Quantum Response Testing (visit www.drbonniejuul.com for a video about Quantum Response Testing), Nutrition Response Testing, ionic detoxification footbaths, emotional freedom technology, PsychK (Psychological Kinesiology), Emotional and Mental Balancing and Repatterning, prayer, meditation techniques, and breathwork.
QUANTUM RESPONSE TESTING: I understand that QRT does not offer diagnoses and is not a medical system or technique. Practitioners of QRT who are not licensed medical providers are licensed as alternative health practitioners and are subject to the parameters as a natural health provider, cannot diagnose, and are solely making recommendations related to foundational health and none related to diagnosis or treatment of disease.
ALTERNATIVES: Alternatives include doing nothing, relying solely on drug therapy, or consulting with other providers. Chiropractic is a branch of the healing arts distinct from other branches (e.g. nursing, osteopathic, or allopathic). I understand that the doctor in this practice is a doctor of chiropractic who has post-graduate education in functional medicine and clinical nutrition and that diagnosing and treating human diseases or ailments is within the scope of chiropractic practice. Nonetheless, we encourage you to communicate with your other health providers about the care you receive, especially as it relates to your medications.
RISKS: Nutritional remedial measures and supplements used in our practice are considered safe; Most of the supplements recommended in this office are food-based, do not interact with medications and most are appropriate when pregnant. If stronger or herbal supplementation is required in your case, these stronger supplements may interact with certain drugs, and some may be inappropriate during pregnancy. Some supplements may cause symptoms, without limit, changes in blood sugar, or gastrointestinal upset and are often related to the detoxification process of your body. If this occurs, I understand that I must contact the office immediately to make adjustments to my plan.
GUARANTEE I understand that the assessments and recommendations are not an exact science and that I expect the Health Professionals to make judgments in my best interest based on the facts as known to them at the time. I understand that my health improvements will depend on my efforts in implementing the recommendations made to me and staying in communication with my provider. I also acknowledge that no guarantees or assurances have been made concerning the outcomes of these treatments. Every individual responds to care differently and no guarantee or assurance is made as to the results of care in any specific case, as care may not improve your condition or result in reducing medications. We can, however, speak of our experience treating functional imbalances, and the success seen in our office has been excellent. Success includes documented subjective or objective functional improvement.
*We appreciate your understanding and commitment to these policies. Your health and well-being are our top priorities, and we are honored to be part of your journey to better health.*