Amend Medical Records Policy:
As a patient of our practice, if you think the information that is contained in your medical and/or billing records is incorrect or inaccurate, you can request a change, update, or revision to your records. You can complete and submit a Amend Medical Records Request Form. Please note: The doctor has a right to determine if the request (for change, update and/or revision) will be made. To request a change, update, or revision of your medical records, contact us at (240) 264 - 6372 and we will email the form to you.
Appointment Cancel or Reschedule Policy:
If you decide that your appointment date/time does not work for you, please be sure to let us know at least 24-hours prior to your scheduled appointment. If you do not notify us within the proper time frame, we may charged $25 for a missed appointment.
Doctor's Service Request:
If you would like to request the doctor to complete paperwork, you can complete and submit a Doctor's Service Request Form. The only documentation regarding patient health required by law (and included in the visit charge) is a visit note. Therefore, the completion of documents for school, summer camp, childcare, employment physical, and/or disability, the Family Medical Leave Act (FMLA), short-term and long-term care, life insurance, the Department of Veterans' Affairs disability claims, or other purposes may go beyond routine chiropractic care. The patient is responsible for payment of this service. To request the Doctor to complete any paperwork, contact us at (240) 264 - 6372 and we will email the form to you.
Employment Visit Policy:
We will not provide services to you at your place of employment without prior written authorization from your employer.
Our fees are set to be competitive and yet, affordable for any budget. Additional fees may apply for appointments that are outside of our normal hours of operation; and our Normal Travel Area Locations.
***IMPORTANT NOTICE: *Services provided After Hours are subject to an additional $30 providing that you receive care in our Normal Travel Area Locations. If you are outside of our Normal Travel Area Locations, you will be charged an access fee of $30 and an additional $1 per mile. ***
Medical Records Authorization Release Policy:
Patients who are requesting copy of their medical records to be released to another healthcare provider or authorized personnel, should complete and submit a Medical Records Authorization Release Form. The patient's medical record cannot be released without written authorization from the patient and/or legal guardian. To request a copy of your medical records to be sent to someone else, contact us at (240) 264 - 6372 and we will email the form to you.
Medical Records Request Policy:
Patients can request a copy of their medical records at anytime for personal use. Complete and submit a Medical Records Request Form. Other personnel such as attorneys and/or healthcare providers are not allowed to request a copy of the patient's medical records without written authorization from the patient. To request a copy of your medical records, contact us at (240) 264 - 6372 and we will email the form to you.
No-Show and Late Arrivals Policy for a Scheduled Appointment:
Please call ahead if you are running late. If you are more than 10 minutes late for your scheduled appointment, you will have to reschedule. Patients who are on-time for their scheduled appointment will be seen before those who arrive late. A no-show is considered a missed appointment, and you will be charged $25 for a missed appointment.
Payment Method Policy:
We accept credit card and debit card payments only. Cash, personal checks, or money orders will not be acceptable as a form of payment from an individual. Payment by check may be acceptable as a form of payment by an established business (or corporation). Credit and debit card payments will be processed using a POS (point-of-sale) system such as Square. Returned checks are subject to a $35.00 fee. We DO NOT accept insurance (e.g. health insurnace) as a form of payment, but you may submit your service receipts to your health insurnace provider for reimbursement. Reimbursement for services provided by us by your health insurnace company, is not a guarantee. Contact your heatlh insurance provider for more information.
Payment for services and/or products are due prior to, or at the time it is provided, unless other payment arrangements have been made.
This practice is required by law, to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information. Click the button, Read Notices of Privacy Practices, for full document.
You should call us at least three (3) days in advance to provide necessary information needed to complete a referral request. Information include: patient name, patient date of birth, phyisican name, physical practice address/location, practice phone number and fax number, date of the appointment, and purpose of referral. WE DO NOT MAIL REFERRALS.
Refusal of Service Policy:
We reserve the right to refuse services to anyone, at anytime for any reason. The refusal of services is at the sole discretion of the doctor. In the event that a patient is refused services and the services was not provided, the patient will be refunded (if paid for services in advance). In the event that a patient is refused services and it was determined while services was being (or about to be provided), the patient will not be refunded (if paid for services in advance) and the patietn will be charged full payment for the visit and all future appointments will be cancelled; and documented in the patient's medical file.
Same Day Appointment Policy:
We offer same-day appointments, providing that you call ahead at least three (3) hours before the end of the shift; and we have availability.
Scheduled Appointment Policy:
Although scheduled appointments are not necessary, they are highly recommended to avoid unnecessary wait-times. You can easily make an appointment by calling us at (240) 264 - 6372 or scheduling online. It is our practice to take patients who have a scheduled appointment before walk-ins.
Services provided After Hours are subject to an additional $30 providing that you receive care in our Normal Travel Area Locations. If you are outside of our Normal Travel Area Locations, you will be charged access fee of $30 and an additional $1 per mile.
Walk-In Policy at a Site Location*:
Walk-in appointments are for urgent chiropractic care appointments which can generally be handled in the same day at a Site Location. The doctor will address one issue during the visit. If you "walk-in" and expect to be seen without an appointment, you may wait until scheduled appointments have been seen before you. If you are experiencing an emergency, please go to the nearest emergency room or call 9-1-1.
*Site Location: is defined as a location where Butler's Mobile Chiropractic is scheduled to be parked at on a specfic day and time. Site Location may vary and is subject to change (The Site Locations will be listed on our Homepage of our website). Patients will be seen by appointment and/or as walk-ins at the Site Location.