Confidential Patient History (130 KB)

Notice of Information Practices (54 KB)

Bournemouth Back Questionnaire (48 KB)

Bournemouth Neck Questionnaire (48 KB)

Office Policies:

1. $25 charge for appointments missed without 24 hours notice.
2. Co-pays, deductibles and fees collected at the time of service.
3. Outstanding balances collected before treatment.
4. Deductibles – when not met at time of visit, office visit fee will be collected and applied toward patient’s deductible.
5. Orthotics – 50% reimbursed if returned within 60 days
6. If insurance company has not paid the claim within 60 days, a copy of that unpaid claim will be given to the patient and the patient will be responsible to follow up on the status of the payment.
7. Services not covered by your insurance, ex. acupuncture or IMS (intra-muscular stimulation), are due at the time of service.