Payment and Office Policies
Iniviual clients are responsible for fees prior to or at the initial appointment. Cindy does not accept insurance, however, she will provide you with a super bill for your own reimbursement. Visits are eligible for work health savings account reimbursement.
Accepted Payment Methods:
All payments are expected either before or at the time of service. You may choose from the following options.
Cash or check made payable to Cindy Carroll is preferred.
Pay pal or credit card.
Installment payment options available for three-month program.
Payment of Fees Agreement
As a patient of Cindy Carroll, RD, LDN, RN, a nutrition consultant with Nutrition To Fit You, I hereby acknowledge and agree to the following conditions as it applies to nutrition and wellness counseling and payment of fees to Cindy Carroll, RD, LDN, RN.
1. I am responsible for understanding my own insurance coverage and agree to contact my insurance carrier to determine if treatment is covered with an out of network provider. If I choose to submit for reimbursement. I understand that Cindy will not process my insurance claim to my insurance appointment. It is my responsibility to process my claim if I want to receive reimbursement.
2. I understand that I am responsible for obtaining a referral from my primary care physician and keeping it current, if my insurance requires it to be eligible for payment of nutrition services.
4. I agree to pay for all services at the time of visit or before via check, cash or credit card.
5. I understand I may be charged $50 for a no show or cancellation within 24 hours notice of my appointment.
6. A $25 fee will be charged for any checks returned for insufficient funds, plus any bank fees incurred.
I have read the above information and agree to all payment of fees as outlined above as they pertain to nutrition and wellness consulting with Cindy H. Carroll, RD, LDN, RN.
I also realize my work with Cindy H. Carroll RD, LDN, RN and the information and care she gives to me is not a substitute for examination, diagnosis or treatment by a physician, particularly in an emergency. If you believe you have a medical emergency, you should immediately call 911 or your physician. Never disregard medical or professional advice, or delay seeking it because of something you read on nutritiontofityou.com or care given by Cindy H. Carroll, RD, LDN, RN. Reliance on any information provided on nutritiontofityou.com or any linked websites is solely at your own risk.
Thank you for your cooperation!
Patient Signature Date