TERMS OF SERVICE

Effective Date: Oct. 16, 2024

Welcome to ACHV Physical Therapy, Inc. These Terms of Service (the "Agreement") govern the use of the outpatient physical therapy services provided by [ACHV Physical Therapy Inc.] ("the Clinic," "we," "us," or "our") located at 15315 Magnolia Blvd. Suite 105 Sherman Oaks, CA 91403. By engaging in our services, you ("the Patient" or "you") agree to be bound by the terms and conditions outlined below. If you do not agree to these Terms, you should not use our services.

1. SERVICES PROVIDED

1.1 Treatment: The Clinic provides physical therapy services including but not limited to evaluations, treatments, rehabilitative exercises, manual therapy, and education aimed at improving mobility, strength, and overall physical health.

1.2 Professional Staff: All services are provided by licensed physical therapists (PTs) and/or physical therapist assistants (PTAs) who are qualified to assess and treat a range of musculoskeletal and neurological conditions. The Clinic’s staff will collaborate with you to create an individualized treatment plan based on your needs.

1.3 Referrals: For patients requiring a physician referral, the Clinic will comply with all legal and insurance requirements regarding physician referrals for physical therapy. In California, physical therapy may be provided without a referral for up to 45 days or 12 visits under Direct Access laws.

2. PATIENT RESPONSIBILITIES

2.1 Accurate Information: You agree to provide accurate and complete information about your medical history, current health status, medications, and any other relevant health information necessary for your treatment.

2.2 Active Participation: You are expected to actively participate in your treatment plan and attend scheduled appointments as recommended by your therapist. Compliance with treatment recommendations is important for achieving the desired outcomes.

2.3 Payment for Services: You are responsible for payment of all charges for the services provided, including co-pays, deductibles, or any non-covered services not reimbursed by your insurance provider. If you are responsible for payment, you must ensure timely payment.

2.4 Cancellations and No-Show Policy: If you need to cancel or reschedule an appointment, you must notify the Clinic at least 24 hours in advance. Failure to provide notice will result in a no-show fee of $50. Repeated cancellations or no-shows may result in termination of treatment.

3. INSURANCE AND PAYMENTS

3.1 Insurance Coverage: The Clinic accepts insurance from most major providers, including Medicare, Medi-Cal, and private health insurers. It is your responsibility to verify insurance coverage, including deductibles, co-pays, and any limitations on physical therapy benefits. The Clinic will assist with claims, but payment remains your responsibility.

3.2 Payment for Services: Payments not covered by your insurance, including co-pays or uncovered services, must be paid at the time of service. You may be asked to provide a credit card or other payment method for outstanding balances.

3.3 Insurance Billing: The Clinic will submit claims to your insurance carrier on your behalf, and you authorize us to release necessary information to your insurer for billing purposes. In some cases, you may be required to pay for services directly and then seek reimbursement from your insurer.

3.4 Financial Responsibility: If you are unable to pay in full at the time of service, you may be eligible to set up a payment plan. Please contact the Clinic's billing department for more information.

4. CONFIDENTIALITY AND PRIVACY

4.1 HIPAA Compliance: The Clinic adheres to the privacy and confidentiality standards outlined in the Health Insurance Portability and Accountability Act (HIPAA). Your personal and medical information will not be shared with third parties without your written consent, except as required by law or for the purpose of treatment, payment, and healthcare operations.

4.2 Notice of Privacy Practices: You will be provided with the Clinic's Notice of Privacy Practices, which outlines how your personal health information is collected, used, and protected. By engaging our services, you acknowledge that you have received and reviewed this notice.

5. CONSENT FOR TREATMENT

5.1 Informed Consent: By accepting these Terms of Service, you consent to receiving physical therapy services at the Clinic. You acknowledge that the Clinic will explain the nature, risks, and benefits of the treatment plan developed for you. You have the right to ask questions and withdraw consent at any time during your treatment.

5.2 Minors: If you are under 18 years old, a parent or legal guardian must provide consent for treatment on your behalf. The responsible adult must also ensure that you comply with the treatment plan.

6. TREATMENT LIMITATIONS AND WARRANTIES

6.1 No Guarantees: While the Clinic strives to provide high-quality care, there are no guarantees regarding the outcome of physical therapy treatments. The success of physical therapy is dependent on many factors, including your participation, medical condition, and adherence to the prescribed treatment plan.

6.2 Health Risks: You understand that there may be risks associated with physical therapy, including soreness, discomfort, or temporary aggravation of symptoms. These risks will be explained by your therapist, and alternative treatments may be discussed if necessary.

7. CANCELLATION AND TERMINATION POLICY

7.1 Appointment Cancellation: You must cancel any scheduled appointment at least 24 hours in advance to avoid a cancellation fee of $50.

7.2 Termination of Services: The Clinic reserves the right to terminate or suspend treatment for any of the following reasons:

  • Non-payment of services

  • Repeated failure to attend appointments

  • Failure to comply with treatment recommendations

  • Behavior that is disruptive, harmful, or non-compliant with Clinic policies

7.3 Patient Request for Discontinuation: You may request to discontinue treatment at any time. However, it is recommended that you consult with your therapist before making this decision to ensure a safe transition from care.

8. DISPUTE RESOLUTION

8.1 Informal Resolution: If a dispute arises, we encourage you to contact the Clinic’s management team directly to resolve the issue. We will make a good-faith effort to address your concerns and find a mutually agreeable solution.

8.2 Arbitration: If informal resolution is unsuccessful, any dispute arising out of or related to these Terms of Service shall be resolved through binding arbitration in accordance with the rules of the American Arbitration Association. The arbitration will take place in Sherman Oaks, CA.

9. AMENDMENTS TO TERMS OF SERVICE

The Clinic reserves the right to modify or update these Terms of Service at any time. Any changes will be posted on our website and become effective immediately upon posting. By continuing to receive services after such changes, you agree to be bound by the updated Terms of Service.

10. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of California. Any legal action or proceeding arising out of or related to this Agreement shall be subject to the jurisdiction and venue of the courts located in Los Angeles, CA.

SMS Terms & Conditions

1- SMS Consent Communication:

The information (Phone Numbers) obtained as part of the SMS consent process will not be shared with third parties for marketing purposes.

2- Types of SMS Communications:

If you have consented to receive text messages from ACHV Physical Therapy Inc., you may receive messages related to the following (provide specific examples):

  • Appointment reminders

  • Follow-up messages

  • Billing inquiries

Example: "Hello, this is a friendly reminder of your upcoming appointment with Dr. [Name] at [Location] on [Date] at [Time]. You can reply STOP to opt out of SMS messaging from (Brand Name) at any time."

3- Message Frequency:
Message frequency may vary depending on the type of communication. For example, you may receive up to [5] SMS messages per day related to your [appointments/billing, etc.].

Example:
"Message frequency may vary. You may receive up to 2 SMS messages per week regarding your appointments or account status."

4- Potential Fees for SMS Messaging:

Please note that standard message and data rates may apply, depending on your carrier’s pricing plan. These fees may vary if the message is sent domestically or internationally.

5- Opt-In Method:

You may opt-in to receive SMS messages from ACHV Physical Therapy Inc. in the following ways

  • Verbally, during a conversation

  • By submitting an online form

6- Opt-Out Method:

You can opt out of receiving SMS messages at any time. To do so, simply reply "STOP" to any SMS message you receive. Alternatively, you can contact us directly to request removal from our messaging list.

7- Help:

If you are experiencing any issues, you can reply with the keyword HELP. Or, you can get help directly from us at www.achvpt.com

Additional Options:

  • If you do not wish to receive SMS messages, you can choose not to check the SMS consent box on our forms.

8- Standard Messaging Disclosures:

  • Message and data rates may apply.

  • You can opt out at any time by texting "STOP."

  • For assistance, text "HELP" or visit our [Privacy Policy] and [Terms and Conditions] pages.

  • Message frequency may vary