Policies and Consent for Treatment (Page 6 of 7)
General Payment Policy: I understand that a deposit of half (50%) of the total program fee is due upon my completion of the registration form (or the signing of the letter of agreement in the case of team building with professional organizations). I further understand that the program fee is to be paid in full at least 14 days prior to the first day of the program. Payment can be made with cash, check written out to Stable Transformation, or credit card via Square. I understand that I will be charged a $35 service charge on all returned checks.
Return Policy: I understand that if I cancel my participation in a Stable Transformation program more than 14 days before the program begins, Stable Transformation will refund my program fee in full. If I cancel more than 7 days but less than 14 days before the program begins, Stable Transformation will refund half (50%) of my program fee. If I cancel 7 days or less before the program begins or no show once the program begins, then I forfeit all of my program fee and Stable Transformation will not refund any portion of the fee. In the event that a program is canceled by Stable Transformation and unable to be rescheduled by Stable Transformation, you will be due a full refund of your paid program fee; however, you will be responsible for the costs associated with changes to any and all travel arrangements
Release of Medical Information to Clinical Contracts or Stable Transformation, LLC Clinical Employees: By signing this agreement I am granting full consent for release of information to any other Stable Transformation, LLC clinical personnel who may be involved in my care, treatment planning, equine therapy activities, or related clinical services. Signing this agreement also serves as consent to release information needed to file claims made to insurance companies.
Privacy Policies: All sessions and their content, as well as the client’s records will be kept strictly confidential. To the extent possible, clients will be informed before confidential information is disclosed, and in that event only the essential information will be revealed. Clients may request restrictions on the uses or disclosures of Protected Health Information, with the exceptions listed below. Diagnosis may be made; if so, diagnosis becomes a part of the client records. The only times a client’s records may be shared without your consent are: 1) Client is in danger to self or others, 2) Therapist has knowledge of client being abused or neglected and/or 3) Disclosure is required by the court.
Emergency Policy: In the case of an emergency, go to the nearest Emergency Department or call 911.
Return Policy: I understand that if I cancel my participation in a Stable Transformation program more than 14 days before the program begins, Stable Transformation will refund my program fee in full. If I cancel more than 7 days but less than 14 days before the program begins, Stable Transformation will refund half (50%) of my program fee. If I cancel 7 days or less before the program begins or no show once the program begins, then I forfeit all of my program fee and Stable Transformation will not refund any portion of the fee. In the event that a program is canceled by Stable Transformation and unable to be rescheduled by Stable Transformation, you will be due a full refund of your paid program fee; however, you will be responsible for the costs associated with changes to any and all travel arrangements
Release of Medical Information to Clinical Contracts or Stable Transformation, LLC Clinical Employees: By signing this agreement I am granting full consent for release of information to any other Stable Transformation, LLC clinical personnel who may be involved in my care, treatment planning, equine therapy activities, or related clinical services. Signing this agreement also serves as consent to release information needed to file claims made to insurance companies.
Privacy Policies: All sessions and their content, as well as the client’s records will be kept strictly confidential. To the extent possible, clients will be informed before confidential information is disclosed, and in that event only the essential information will be revealed. Clients may request restrictions on the uses or disclosures of Protected Health Information, with the exceptions listed below. Diagnosis may be made; if so, diagnosis becomes a part of the client records. The only times a client’s records may be shared without your consent are: 1) Client is in danger to self or others, 2) Therapist has knowledge of client being abused or neglected and/or 3) Disclosure is required by the court.
Emergency Policy: In the case of an emergency, go to the nearest Emergency Department or call 911.