Office Policies

Medical Consent:
I consent to all care, treatment, diagnostic imaging, laboratory testing, and other medical procedures performed or prescribed by the physicians and designees of Neurovations Neurology Clinic. I understand that this consent encompasses all necessary interventions deemed appropriate for my medical care and treatment.

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Right of Refusal of Treatment:
I understand that I have the right to make informed decisions regarding all aspects of my care. I am encouraged to ask my healthcare provider for further clarification or explanation if needed. I acknowledge my right to refuse any treatment.

Acknowledgment of Receipt of Patient Rights & Notice of Privacy Practices:
I confirm that I have received and reviewed the Notice of Patient Rights/Responsibilities and the HIPAA Notice of Privacy Practices.

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Release of Medical Information:
I authorize Neurovations Neurology Clinic to release any medical information necessary to facilitate healthcare claims processing, payment audits, or other administrative functions related to my care. Additionally, I consent to the release of information to other facilities, agencies, or healthcare providers as deemed appropriate by Neurovations Neurology Clinic. This authorization remains in effect until I revoke it in writing.

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Financial Policy:
I certify that the insurance information provided to Neurovations Neurology Clinic is accurate, complete, and current. I acknowledge that it is my responsibility to understand my insurance plan's terms and benefits. I accept financial responsibility for any charges not covered by my insurance. I understand that co-payments, co-insurance, or deductibles may be required at the time of service unless alternative arrangements are made in advance. Neurovations Neurology Clinic will make a reasonable effort to inform me if a service is not covered by my insurance. If my insurance company has not paid my bill in full within 60 days, I agree to pay the remaining balance within 30 days. For large balances, such as those arising from surgical procedures, Neurovations Neurology Clinic may offer a payment plan.

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Appointment No-Show / Cancellations:
If I need to cancel or reschedule my appointment, I will do so at least 24 hours before the scheduled time. Failure to cancel within this time frame or failing to attend the appointment without notice will result in a $100.00 fee, which I am responsible for and cannot be billed to insurance.

Returned Checks:
I acknowledge that a $25.00 fee will be added to my account for any returned check.