We reserve the right to charge you $40 for any and all missed appointments or appointments cancelled without ample notice (12-24 hours).
When you miss or cancel an appointment it affects three people. The Doctor and Staff who are here, ready to help you and THE PATIENT who couldn't get in because we reserved that time for you.
Please be courteous and let us know in advance if you are unable to keep your appointment. Cancellations can be made over the phone at 716-965-4343, even when we are not in the office. Please leave a message with your name, phone number, and the reason for canceling, so we can let the doctor know everything is okay!
In order to facilitate a patient's visits, Forestville Chiropractic, P.C. accepts Cash, Checks, All major credit cards, and Care credit payments ONLY.
- Checks should be made out to Forestville Chiropractic, P.C.
- Returned fee of $35 plus the original fee is due within 3 business days.
- Receipts or statements requested after the initial visit will incur a $1 fee per receipt or statement over five pages.
- Re-evaluation fee will be charged to patients who have not been seen in 6 months or more, occasionally the doctor will reevaluate during treatment which can also incur additional fees. If it has been 3 years or more, you will be considered a new patient and will be charged for an initial exam and consultation with our office.
We DO NOT accept cases due to work-related injuries or auto accidents. The Patient is aware that their insurance company may NOT be billed for treatment following such injuries as it constitutes insurance fraud. If you've been involved in such an accident during your care at our office, we ask for you to let us know at the front desk or to call 716-965-4343, so that we can refer you to a practitioner who specializes in these types of cases.
I understand that under the Health Insurance Portability and Accountability Act (HIPAA), I have certain rights to privacy regarding my protected health information. I acknowledge that I have received or have been given the opportunity to receive a copy of Forestville Chiropractic P.C. Notice of Privacy Practices (NPP). I also understand that this practice has the right to change its Notice of Privacy Practices and that I may contact the practice at any time to obtain a current copy of the Notice of Privacy Practices. Signing the NPP Acknowledgement does not mean that you have agreed to any special uses or disclosures (sharing) of your health records. Refusing to sign the acknowledgement does not prevent a provider or plan from using or disclosing health information as HIPAA permits. If you refuse to sign the acknowledgement, the provider must keep a record of this fact.
9:00am - 1:00pm
2:00pm - 6:00pm
9:00am - 1:00pm
4:00pm - 6:00pm
9:00am - 11:00am