VITALITAS DENVER CANCELLATION POLICY

Please review the following information about the Vitalitas Denver PAYMENT & cancellation policy. Acknowledge your review, understanding and acceptance of this policy by checking the box at the bottom of this page.

I. Payment

I understand, acknowledge, and agree that I am fully responsible for payment of services provided to me by Vitalitas and that payment must be made in full at the time of service.  I understand that treatment and services provided by Vitalitas may not be covered by my insurance.  Vitalitas does not contract with any insurance plan.  Vitalitas will provide information to me to assist me in my claim for reimbursement from my insurance carrier, but will not submit claims to insurers on my behalf.  I further acknowledge and agree that if I choose to submit any bill or itemized receipt to an insurance carrier for reimbursement for these services, that Vitalitas is exempt from any dispute regarding reimbursement.

II.  Cancellation

To fairly and effectively serve patients who wish to receive treatment, the following cancellation policy has been implemented.  By your signature below you acknowledge and agree to the following cancellation policy:

Forty-minute infusions must be cancelled at least 72 hours in advance.  Those infusions cancelled at least 72 hours in advance will receive a full refund.  Those infusions cancelled less than 72 hours in advance will incur a $325 charge, payable by funds pre-paid to your account or charged to your credit card on file.

Two, Three and Four-hour infusions must be cancelled at least two weeks in advance.  Those infusions cancelled at least two weeks in advance will receive a full refund.  Those infusions cancelled less than two weeks in advance will incur a $500 charge, payable by funds pre-paid to your account or charged to your credit card on file.

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