Positively Chiropractic Company Description & Clinic Policies Our Mission: Always Moving Forward Founded in 2000, Positively Chiropractic is built on three core principles centered around movement and a commitment to helping every patient move forward toward a healthier, more active life. At Positively Chiropractic, we believe movement is fundamental to health, healing, and overall well-being. Healthy joint function, flexibility, circulation, and physical activity all play important roles in how we feel and function every day. Our goal is to help patients improve mobility, address pain, support recovery, and maintain an active lifestyle. Our comprehensive services include Chiropractic care, Therapeutic Massage, Active Release Technique®, Softwave Therapy, acupuncture, and movement-based rehabilitation utilizing Spinal Rehab tools. Through personalized treatment plans, we help patients work toward improved function, enhanced recovery, and their individual health and wellness goals. Our mission, “Always Moving Forward,” reflects our commitment to every patient, whether they are recovering from an injury, pursuing peak athletic performance, or seeking greater confidence in everyday life. We treat every patient with passion, purpose, and personalized attention, helping them build a stronger foundation for lasting wellness and return to the activities they love. Clinic Policies & Patient Financial Agreement Please review the following policies carefully. Patients are responsible for understanding and complying with applicable office policies. 1. Payment & Fees Payment and applicable copayments are due in full when services are rendered. Prepayment may be accepted on a case-by-case basis. Fees charged at this clinic may differ from those charged at other clinics. A general schedule of services and fees is available upon request at the front desk or on our website at www.posichiro.com. 2. Appointment Cancellations & Missed Appointments Please contact our office as soon as possible if you need to cancel or reschedule an appointment. Chiropractic Appointments: Patients who miss or cancel a Chiropractic Appointment without at least 24 hours’ notice will be responsible for a $50 cancellation fee. Massage & Acupuncture Appointments: Patients who miss or cancel a massage or acupuncture appointment without at least 24 hours’ notice will be responsible for the full cost of the scheduled service. 3. Discontinuation of Care & Outstanding Balances If a patient discontinues care for any reason, any outstanding balance becomes due and payable, subject to applicable law and any applicable payment arrangements. Insurance claims that have been submitted or are pending do not eliminate the patient's responsibility for amounts owed. Requests for medical records, including X-rays, will be handled in accordance with applicable laws and regulations. 4. Delinquent Accounts & Collections If a patient's account becomes delinquent, Positively Chiropractic may notify the patient by email, text message, mail, or phone. Patients are responsible for timely payment of all outstanding balances. Additional fees may apply if the balance is not paid in a timely manner, as permitted by applicable law. 5. Product Refund Policy Products purchased from this office are non-refundable, excluding orthotics. Orthotics may be eligible for a full or partial refund on a case-by-case basis. 6. Returned Check Fee A $30 returned-check fee will be charged in addition to the original amount of the returned check, subject to applicable law. 7. Massage Appointment Preparation To promote a comfortable treatment experience for both patients and providers, patients who have recently exercised or engaged in strenuous physical activity are encouraged to shower before attending their massage appointment whenever possible. 8. Insurance Billing Depending on the patient's insurance plan and coverage, Positively Chiropractic may submit insurance claims on the patient's behalf as a courtesy. This service may be discontinued at the office's discretion, subject to applicable contractual and legal obligations. 9. Primary & Secondary Insurance Patients with more than one insurance carrier are responsible for providing accurate information regarding all applicable coverage. Unless otherwise agreed or required, this office will submit claims to the primary insurance carrier, and patients are responsible for coordinating secondary insurance billing. For eligible Medicare patients, this office may also submit claims to Medicare supplemental plans when applicable. 10. Insurance & Contact Information Patients must provide accurate insurance and contact information at their first visit. Patients are responsible for notifying the front desk promptly of any changes to their insurance coverage, mailing address, phone number, or other relevant information. 11. Deductibles, Coverage & Medical Necessity If a patient's insurance plan includes a deductible, applicable charges may be applied toward that deductible in accordance with the plan's terms. Positively Chiropractic does not guarantee that an insurance company will pay any portion of the fees charged. All claims are subject to the insurer's review of coverage, eligibility, benefits, and medical necessity. Patients remain responsible for charges not covered or paid by their insurance, subject to applicable law and any applicable contractual obligations. 12. Insurance Payment Disputes Positively Chiropractic does not guarantee insurance reimbursement and is not obligated to pursue disputes with an insurance company regarding denied or reduced payments on a patient's behalf. Patients may contact their insurance carrier directly regarding coverage determinations, claim denials, or reimbursement questions. 13. Chiropractic Re-Examinations If six months or more have elapsed since a patient's last chiropractic treatment, the next appointment may be scheduled as a chiropractic re-examination. An additional re-examination fee may apply, and the patient will be informed of the applicable charge. 14. Independent Contractors Patients acknowledge that practitioners other than Dr. Kathy Coutinho operate as separate and independent contractors of Positively Chiropractic. Each practitioner's responsibilities are subject to applicable law and contractual arrangements. 15. Authorization to Communicate by Text and Email Electronic Communications Patients consent to receive appointment reminders, billing notifications, treatment-related communications, and other practice information via phone call, voicemail, text message, and email using the contact information provided. Standard message and data rates may apply. Patients may revoke their electronic communication preferences in writing, subject to communications necessary for treatment, billing, or legal obligations and applicable law. 16. Minor Patients A parent or legal guardian must accompany patients under 18 years of age during their initial visit and is financially responsible for all charges incurred by the minor patient, subject to applicable law. 17. Medicare and Non-Covered Services Certain services provided by this office may not be covered by Medicare. Patients may be required to sign an Advance Beneficiary Notice (ABN) or similar form acknowledging financial responsibility before receiving services that may not be covered, as applicable under Medicare rules. Thank you for choosing Positively Chiropractic! We appreciate the opportunity to be part of your health and wellness journey. Our team is committed to providing personalized care and helping you keep moving forward. Positively Chiropractic 5105-A Backlick Road Annandale, VA 22003 Phone: 703-642-8685 Website: www.posichiro.com