Welcome, and thank you for your interest in becoming a client. 
 

This form helps me determine whether my practice is an appropriate fit for your clinical care needs and treatment goals, based on clinic availability. Submitting this form does not guarantee a booking. If your request is accepted, you will be contacted with booking access and further details.
 

Please reveiw the Practice Policies below before completing the New Client Intake Form. By submitting this form, you confirm that you have reviewed and agree to the Practice Policies above. 

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Practice Policies
 

As a regulated healthcare practice, appointments, records and insurance claims are governed by professional and legal requirments.
By becoming a client of this practice and booking an appointment, you acknowledge and agree to the following policies. These policies exist to ensure a safe, respectful, and professional environment for both clients and practitioner.

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Professional Conduct & Respectful Boundaries

This is a regulated health care practice operating within professional and ethical standards.

Clients are expected to:

 

• Engage respectfully and appropriately at all times

• Honor professional boundaries before, during, and after treatment

• Communicate in a manner consistent with a professional health care setting

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Disrespectful, inappropriate, or boundary-violating behavior — including verbal, written, or physical conduct — will result in immediate termination of care and loss of booking access.

 

Cancellation, Late Arrival & Missed Appointment Policy

Appointment times are reserved exclusively for you.

 

• Cancellations or changes made within 24 hours of the scheduled appointment time will incur a fee equal to the full cost of the reserved treatment.

• Missed appointments (no-shows) are charged the full treatment fee.

• Late arrivals may result in a shortened session in order to respect subsequent bookings. The full appointment fee still applies.

• If a client arrives more than 15 minutes late without prior email notification, the appointment is considered missed/forfeited and will be treated as a no-show. The full appointment fee applies.

 

Future bookings will not be secured until all outstanding fees are paid in full.

This policy ensures fairness to the practitioner and to other clients waiting for care.

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Payment Policy

Payment is due at the time of service.

Appointments are not considered complete until payment has been rendered. Outstanding balances will result in restricted booking access until the account is settled.

Direct Billing (Insurance)

Direct billing is offered as a convenience, not a guarantee. Insurance coverage, eligibility, and required documentation (including physician notes) are the responsibility of the client.

If a claim cannot be processed for any reason, payment is required at the time of the appointment. An RMT receipt will be provided for the client to submit directly to their insurer.

 

Scope of Practice

All treatments are provided within the practitioner’s professional scope, training, and regulatory standards.

Requests for services outside of scope, inappropriate modifications, or non-clinical expectations will not be accommodated.

Agreement to Policies

By booking an appointment and/or becoming a client of this practice, you confirm that you have read, understood, and agreed to these policies.  Failure to comply with these policies may result in cancellation of appointments and/or termination of the client-practitioner relationship.

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