This policy statement applies to the following services:

1. Fitness and/or Wellness consultation
2. Therapeutic Massage
3. Orthotics fitting

We require a minimum of 24 hours notice for cancellation or rescheduling of appointments.

An inconvenience fee will be charged if:

1. We do not receive at least 24 hours notice, AND
2. Client cannot reschedule at ZPT's convenience within one (1) calendar week of the scheduled appointment.

Inconvenience fee is 50% of the billable amount for the scheduled session.

If an inconvenience fee is charged, further sessions cannot be scheduled or initiated until it is paid.

We Appreciate Your Cooperation

NOTICE TO MEDICARE BENEFICIARIES

1. At ZPT, we do not accept Medicare.

2. If you are a Medicare beneficiary, you must pay out-of-pocket for your treatment. You must not submit claims to Medicare for your treatment here at ZPT.

PAYMENT POLICY

Zombro Physical Therapy (ZPT) accepts insurance from most major health insurance carriers. We will bill your claims electronically as part of our service.

We reserve the right to refuse any insurance carrier that proves unreliable.

ZPT grants a 10% discount on payment for services which are not billed to insurance. This payment is due at the time of service.

Worker compensation claims require ZPT approval and prior insurance authorization.

Payment for all merchandise is due upon receipt.

THANK YOU FOR YOUR COOPERATION

PRIVACY POLICY

This office, in compliance with the Health Information Portability and Accountability Act (HIPAA), maintains strict standards concerning the confidentiality of all personal, financial, and medical records. Access to such information within this organization is limited to authorized personnel for official purposes only. Disclosure of any of this information is done only with your permission and is limited to the factual information necessary for record-keeping or claims processing. You may also disallow disclosure of these records to others, with the exception of the information necessary to process a claim for payment to this organization. Electronic Data Interchange (EDI) transmission standards are utilized for all electronic exchange of data sets.

It is not necessary for you to disclose your Social Security Number, unless this is a part of your health insurance policy number.

We ask that you give us your email address to make communication regarding scheduling easier. Under no circumstances will we give your email address to anyone else for any reason.

We provide this policy statement not only because we wish to assure you of your legal rights and privacies, but because it is our goal that you are satisfied with our services on all levels.