Terms and Conditions

The following is set forth indicating that upon voluntary participation in services from Lifestyle Physio & Wellness PLLC, the patient, client, or recipient of physical therapy, health, and/or wellness services agrees to the terms and conditions listed below.

EVALUATIONS

The physical therapy evaluations are performed by a licensed physical therapist employed by or under contract with Lifestyle Physio & Wellness PLLC.

The physical therapist fully explains the nature and purposes of the procedures, evaluation, and course of treatment. The physical therapist provides information on expected benefits and possible complications or discomfort which may result from skilled physical therapy care.  In addition, the physical therapist explains the risks of receiving no treatment.

There is no guarantee that the proposed evaluation and/or course of treatment will improve the condition and that it is possible, although unlikely, that the course of treatment may cause additional pain or discomfort or aggravate the condition.

TREATMENT

The treating physical therapist provides care and treatment prescribed by and considered necessary or advisable by the evaluating physical therapist and/or physician(s). The patient/client acknowledges that no guarantees have been made to me about the results of treatment.

WELLNESS

Lifestyle Physio & Wellness PLLC offers wellness programs services, which is health coaching that is provided via an education model. Wellness service is not physical therapy service. The client who receives wellness services and programming from Lifestyle Physio & Wellness PLLC may receive general health education, physical skills training, strengthening programs, and/or balance training, with hands-on assistance as needed.

COMMUNICATION

The patient/client will receive information (such as appointment reminders, patient surveys, and other information relating to the physical therapy and wellness services provided) via the communication channels through which they provide when listing contact information including via phone, text, email, and patient portal.

PHYSICAL THERAPY TREATMENT WITHOUT REFERRAL DISCLOSURE

The patient understands that physical therapy treatment without a referral will be based on the physical therapist’s examination and evaluation of the current condition which may result in identification of movement and mobility dysfunction. The patient understands that the physical therapist will not diagnose an illness or disease, and that physical therapy is not a substitute for a medical diagnosis. The patient understands that if a medical diagnosis has already been established by a qualified healthcare practitioner, the physical therapist will take it into consideration during the evaluation process. The patient understands that the physical therapy plan of care developed by the physical therapist may not be based on radiological imaging. The patient understands that if images have previously been obtained, the physical therapist may use the information as part of the evaluation process. The patient understands that if the physical therapist identifies a need for radiological imaging, the physical therapist may recommend that radiological imaging be obtained. The patient understands that my health insurance may not cover physical therapy services if provided without a referral from a qualified healthcare practitioner. The patient acknowledges that they have received the above disclosure.

FINANCIAL POLICY AND PARTICIPATION AGREEMENT

For optimal patient care, Lifestyle Physio & Wellness PLLC has chosen to be an out-of-network provider. By not having a preferred provider/ contracted status with insurance companies, your PT does not have to limit the time or quality of treatment provided secondary to insurance company restrictions or elevate clinic rates to pay for billing services. Therefore, our payment model utilizes direct pay from the patient/client, and does not utilize or accept payment(s)/reimbursement from insurance companies. We accept debit or credit card payment at the time of your service. You may also use your Health Savings or Flex Spending Account to pay for your services. The rates are as follows: Standard Physical Therapy Initial Evaluation On-site 60 minutes $149; Physical Therapy Follow-up Sessions On-site 60 minutes $129; Physical Therapy Vestibular Initial On-site Evaluation $199; Wellness Initial On-site Consultation & Coaching Session 60 minutes $129; Wellness On-site Follow-up Sessions 60 minutes $129; each subject to change, under which case, the patient or client will be notified and given reasonable opportunity to renew or retract their participation agreement.

I understand that payment is due at the time of service.

I understand my physical therapist cannot become conservator, guardian, or representative payee for me or my family member.

I agree to not leave money, jewelry, or other valuables out in view and will keep these items in a safe secure place.

I agree that I will not lend money to my physical therapist. In addition, I will not sell or purchase personal items, to or from my physical therapist. 

I understand that my physical therapist is not allowed to pay or mail my bills, go to the bank for me, write/cash checks for me or balance my checkbook. I also agree not to give my credit/debit card, PIN, or any financial information, related to accessing my accounts, to my physical therapist. 

ATTENDANCE/COMPLIANCE and CANCELLATION/ NO SHOW POLICY

The patient/client understand that in order for physical therapy treatment or wellness services to be effective, the patient/client must attend their scheduled appointments and be prepared to begin service on time. The patient/client agrees to comply with the plan of care or plan of service, unless there are unusual circumstances that prevent them from participating as planned. The patient/client agrees to call, text, or e-mail Lifestyle Physio & Wellness PLLC as soon as possible if they need to cancel their appointment.

The patient/client understands that cancellations made greater than 24 hours in advance of their scheduled appointment time will not incur a cancellation fee.

The patient/client understands that cancellations made within 24 hours of the scheduled appointment time will incur a $50 cancellation fee.

The patient/client understands that an appointment No Show will incur a fee of 50% of the scheduled service.

The patient/client understands that repetitive cancellations or no shows may result in complete discontinuation or discharge of service.

PHOTO AND VIDEO

In conjunction with the plan of care, the patient/client authorizes the use of recording devices, including, a camera and/or mobile device to record videos and/or images for the purposes of enhancing care. In addition, the patient/client authorizes the transmittal of such recording device videos and/or images to their rehabilitation provider and/or treating physician through secure documentation systems, patient portal(s), email, and/or text message. The patient/client acknowledges that such videos and/or images will only be used or disclosed for evaluation or treatment purposes, and that the provider will not further use or disclose such videos and/or images for any other purpose without written authorization.

WORKPLACE SAFETY

Business will always and only be conducted in safe and sanitary conditions. As a mobile physical therapy practice and wellness service, Lifestyle Physio & Wellness PLLC employees operate within the patient’s/client’s home and/or elective community setting(s). The employee and the patient/client are expected to prioritize and collaborate at all times in order to plan for, create, and maintain the safety of all clients, patients, partners, associates, and employees. Further, for facilitation of safety and health, every reasonable effort will be made by the employee(s), as needed, to facilitate reasonable accommodations to conduct business and service – such as following standard precautions, contact precautions, performing service within limited and exclusively patient-/client-specified room(s), wearing booties, implementing infection control procedures via disinfecting of environment/equipment, limiting extraneous physical contact with client/patient/furniture/equipment/etc. when unrelated to task at hand. Employees of Lifestyle Physio & Wellness PLLC reserve the right to deny and/or discontinue services upon discovery of any unsafe or unsanitary conditions which pose an immediate risk to the employee, including any of the following within the service delivery area: aggressive pets, weapons, pest infestation, mold buildup or any other biohazardous materials, persons exhibiting belligerent, harassing, or abusive behaviors either verbally or physically. In the event of such occurrence, the patient/client maintains responsibility for payment of full scheduled service session time, even if the session time is abbreviated due to any of the aforementioned safety risk reasons.

ACCIDENTAL EXPOSURE OF THE HEALTHCARE WORKER

The patient understands that Texas law provides, if any healthcare worker is exposed to the patient’s blood or other bodily fluid, that Lifestyle Physio & Wellness PLLC may perform test(s) on the patient’s blood or other bodily fluid to determine the presence of human immunodeficiency virus (HIV, the virus associated with AIDS). The patient/client consents to the testing for other communicable diseases, in the event of an accidental exposure to a healthcare worker. The patient/client understands that such testing is necessary to protect those who will be caring for the patient while a patient of Lifestyle Physio & Wellness PLLC.

SUMMARY

Participating in services from Lifestyle Physio And Wellness PLLC – including but not limited to participating in physical therapy screening, consultation, assessment, evaluation, treatment, and/or wellness programs – signifies understanding and agreement to the outlined Terms & Conditions, signifies understanding of the risks, benefits, & alternatives to treatment, signifies voluntarily consent to services from Lifestyle Physio & Wellness PLLC, signifies understanding of the option to choose to discontinue services at any time, signifies understanding of the right to refuse any treatments or procedures, signifies acknowledgement that the delivery of health and wellness services does not guarantee results, signifies understanding that information from any personal or medical record(s) kept by Lifestyle Physio & Wellness PLLC may be used for educational, administrative, and/or company-approved purposes when personal identity will not be revealed.