Cash Plan (Block of 6)

To Patients of Chirocare Chiropractic
Regarding: Block of 6, (Time of Service Fee)

Dear Patient:

We understand we are all in tough economic times, therefore we have implemented a cash discount plan for our patients.

Verifying health benefits, filing invoices with health plans and waiting for payment increases the cost of providing care to our patients. When we receive payment at the
time of service we are able to pass the savings on to you.

This is a Time of Service Fee and the fee must be paid the same day you receive the service (treatment). We cannot charge the Time of Service Fee or send an invoice to you and/or your health plan.

Initial visit, including examination, therapy and chiropractic adjustment (x-rays are not included) - $70.

The Time of Service Fee is a Block of 6 visits and is charged as follows:

Normally 6 visits would equal $270.00 if paid per visit however, if you prepay for the Block of 6 the visits purchased after the initial visit is ($229.50) see chart below:

Regular Block of 6 Savings

*NOTE: This is a non-refundable prepaid plan.

**NOTE: This plan cannot be used for personal injury or worker's compensation claims.