CANCELLATION AND FEE POLICY

Chiropractic                                                 Therapeutic Massage           Physiotherapy
Initial Exam/Treatment        $80         30 min. Massage        $50        Initial Exam/Treatment $100
Chiropractic Office Visit    $45            45 min. Massage        $65       Physiotherapy Office Visit $75
60 min. Massage        $80                      Extended Visit        $75         Shockwave  $125
90 min. Massage        $115                                                                     (+$25 each additional body  part treated)

All prices above include GST if applicable.

This is the current fee schedule for services available at Sundance Chiropractic & Wellness, and may change from time to time with notice.  Discounted prices may be available for seniors and students. Please inquire at the reception desk for details regarding other goods or services.

Please note we can direct-bill some insurance companies as well as WCB on behalf of our clients.  This is a courtesy service, and may not be available for some insurance companies and/or some services. As of July 2012, some insurance plans also may not cover therapeutic massages performed by some therapists; please inquire at the reception desk and your human resources manager for the specific details regarding your plan.

Please note that the client is always responsible for his or her own account for all services rendered in the event that the insurance company or WCB refuses some or all of the reimbursement.

It is the policy of Sundance Chiropractic & Wellness to charge full fees for missed appointments or for canceling any scheduled appointments with less than 24 hours notice.

Dated this _________day of ______________________, 20_____

Patient Name (please print) _________________________________________

Signature ________________________________________________________

Witness _________________________________________________________