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I consent to the policies and procedures read above.
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I authorize my credit card to be charged the day of the appointment and be kept on file.
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I understand no shows and late cancellations of less than 48 hours will incur a $100 fee.
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I am aware that there may be a co-insurance or deductible balance after my claim processes with my insurance carrier. These amounts are based on my individual plan with the insurance carrier. I authorize LunaJoy to charge the card on file for any outstanding insurance balance at that time.
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If you are or believe you are experiencing a medical or psychiatric emergency, including suicidal or homicidal thinking, side effects to medication, or any other urgent or time-sensitive matter in which you need an immediate response, do not use this service. You can access emergency assistance by calling the National Suicide Prevention Lifeline at 1-800-273-8255. This request is not an emergency or urgent matter. I wish to proceed
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Due to federal regulations, we are unable to prescribe controlled substances (Adderall, Ritalin, Xanax, Klonopin, etc). I Understand this.
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