This Financial Responsibility Agreement (“Agreement”) outlines the terms and conditions regarding the financial responsibilities of patients (“you” or “your”) receiving services from NATT Weightloss, Testosterone, and Wellness Clinic (“we,” “us,” or “our”). By receiving services from us, you agree to the following terms and conditions:
Payment for Services
- Service Fees: You are responsible for paying all fees associated with the services provided by NATT Weightloss, Testosterone, and Wellness Clinic. Our fees are subject to change, and you will be notified of any changes in advance.
- Payment Methods: We accept various forms of payment, including credit cards, debit cards, cash, and checks. Payment is due at the time of service unless other arrangements have been made in advance.
- Insurance Claims: While we may assist with submitting insurance claims on your behalf, it is your responsibility to understand your insurance coverage and benefits. Any amounts not covered by your insurance, including co-payments, deductibles, and non-covered services, are your responsibility.
Billing and Statements
- Billing Statements: You will receive a detailed billing statement outlining the services provided and the associated fees. It is your responsibility to review the statement and contact us with any questions or discrepancies within 30 days of the statement date.
- Past Due Accounts: Accounts not paid within 30 days of the statement date are considered past due. We reserve the right to charge a late fee on past-due accounts and to suspend or terminate services until the account is brought current.
- Collections: In the event of non-payment, we may refer your account to a collection agency or take legal action to recover the outstanding balance. You will be responsible for any collection fees, attorney fees, and court costs incurred as a result of non-payment.
Cancellation and Refund Policy
- Cancellation of Appointments: We require at least 24 hours’ notice for the cancellation of appointments. Failure to provide adequate notice may result in a cancellation fee, which you will be responsible for paying.
- Refunds: Refunds for services already rendered are generally not provided. However, if you have prepaid for services that you did not receive, you may be eligible for a refund. Refund requests must be made in writing and will be evaluated on a case-by-case basis.
Financial Hardship
If you are experiencing financial hardship, please contact our billing department. We offer payment plans and financial assistance programs to eligible patients. We are committed to working with you to ensure you receive the care you need.
Changes to This Agreement
We may update this Agreement from time to time. Any changes will be effective immediately upon posting the revised Agreement on our website. Your continued use of our services constitutes your acceptance of the updated terms.
Contact Information
If you have any questions or concerns about this Agreement or your financial responsibilities, please contact us at:
- Email: info@nattww.com
- Phone: 346-558-1815
- Mailing Address: 545 S Mason Rd, Katy TX 77450
Thank you for choosing NATT Weightloss, Testosterone, and Wellness Clinic. We appreciate your cooperation and understanding.
