COACHING SERVICES POLICY UPDATES

Payment:

• Payment is due no later than at the time of service. Cash and credit cards are accepted; however, we do not accept checks.

• Our office requires a credit/debit card on file in our EHR system. If a card is not on file the day prior to your appointment DMV Medical Group reserves the right to cancel your appointment without notice.

Fees:

• Our fee for initial coaching sessions is $200 for individuals and $50 per extra person. Our ongoing rate is $150 for individuals and $50 per extra person.

Late Arrivals:

• If you arrive 10 minutes late to your appointment you may not be seen. If you are seen, your appointment is subject to be shortened appropriately according to your scheduled time. Clients may be subjected to a no-show fee to equal the appointment fee if you do not show up for your appointments.

Appointment Cancellations:

• Once you have scheduled an appointment, you may cancel it without incurring a charge only if you provide notice at least forty-eight (48) hours in advance. You can contact us via phone or message us through your client portal. If you do not provide timely notice, you will be charged a no-show fee to equal the appointment fee if you do not show up for your appointment.

No-Shows/cancellations/late arrivals:

• A "no-show" is someone who misses an appointment without canceling it properly. A failure to be present at the time of the scheduled appointment will be recorded in your record as a "no-show". If you are a no-show for your first appointment with our coach(s), you will be charged $200. A credit card or debit card is required before your first appointment. All no-show fees must be paid before your next appointment.

• If you have two (2) or more "no-shows" you may be discharged from the program.

Scheduling Appointments:

• Appointments can be scheduled days/weeks/ months in advance. This is highly encouraged to ensure you receive the appointment time that you are looking for. It is custom practice to schedule all upcoming appointments during or at the end of the current appointment. This removes any ambiguity of scheduling conflicts.

Confidentiality:

DMV Medical Group will only release your confidential information if there is:

1. Written consent from the patient

2. An indication that clear and immediate danger exists to self or others

3. A court order directing the release of information

Physician Contact:

• Physical and psychological symptoms often interact with prescribed psychotropic medications. I encourage you to seek medical consultation if warranted. In some cases, it may benefit your treatment for me to speak to your primary care provider, in which case I will ask for your permission first.

Freedom to Withdraw from Treatment:

• You have the right to end your coaching session at any time. Please also know that our company reserves the right to end coaching sessions at any time for failure to multiple missed appointments and/or cancellations and failure to adhere to a coaching plan, etc.

Patient Testimonial/ Review:

• By signing this notice, I understand and acknowledge that if I voluntarily share a testimonial/review on the company website about your services, it will be distributed to Tebra, Google, and possibly other social media pages. Any personal information I choose to disclose is not protected. DMV Medical Group, LLC, is not responsible for any personal information being released when distributed voluntarily.