Washington State and Federal No Surprises Act
Good Faith Estimate
PAYMENT AT TIME OF SERVICE & PREPAY SCHEDULES FOR DR. PAT DOUGHERTY, D.C.
The Initial visit cost is $95. For a 60 minute appointment.
Subsequent visits are for 30 minutes and there are 3 options:
1. You can pay $42.
2. You can prepay $170 for 5 visits
3. You can pay $300 for 10 visits
4. Demand for appointment times causes it to be necessary to have a Missed Appointment Policy.
a. A missed appointment without a call for cancellation will result in a charge to you. A first miss may be forgiven with no charge.
b. Calls must be made at least two hours before appointment time.
c. The charge for a missed appointment will be $30 or one your prepaid visits.
d. Missed appointment fees must be paid before the next visit.
e. A pattern of calls only an hour or two before scheduled appointments will not be tolerated and may be grounds for dismissal as a patient.
f. Exceptions can and will be made for extraordinary circumstances.
Prices double for a 60 minute slot. Please be aware that the 30 and 60 minute time slots don’t guarantee you that much treatment time. You have bought a segment of time that includes time for the doctor to clean, schedule and collect fees. Please understand that I will need you to move on when the time is expired. My objective is to always remove the nerve interference in your body. When that is done, or when we run out of time, we are done.
Contract for 10 Chiropractic Adjustments Paid in Advance
Patients can pay for 10 adjustments in advance. The fee for those 10 adjustments shall be $300. When you purchase this you are paying for each of the first 7 treatments. The final 3 are free. Ancillary procedures such as supplements are not included in this price. You are free to withdraw from this contract at any time and receive a refund for unused portions of the fee paid. Money will be refunded on this basis: In the event that all 10 treatments are not received and the contract is cancelled by the patient, said patient will be charged $42 for each adjustment received. The number of visits x $42 will be subtracted from the initial $300 fee at cancellation. Whatever money remains will be returned to the patient within 7 working days.
Contract for 5 Chiropractic Adjustments Paid in Advance
Patients can pay for 5 adjustments in advance. You pay $170 for those 5 adjustments. You are paying $42.50 for each of the first 4 treatments. The 5th treatment is free. Ancillary procedures such as supplements are not included in this price. You are free to withdraw from this contract at any time and receive a refund for unused portions of the fee paid. Money will be refunded on this basis:
In the event that all 5 treatments are not received, and the contract is cancelled by the patient, said patient will be charged $42 for each adjustment received. The number of visits x $42 will be subtracted from the initial $170. Money will be returned to the patient within 7 working days.