Terms and Conditions

Terms and conditions

Privacy Policy

1. Membership Plan Overview

Plan Name: Monthly Therapy Membership Program

Monthly Fee: $350

Included Services:

• One (1) session per week, forty-five (45) minutes each
• Total of four (4) sessions per month

Therapist: All sessions are performed by a licensed physical therapist under the clinical direction of 3A's Physical Therapy, PLLC.

Initial Evaluation Requirement:
All new members are required to complete an Initial Evaluation, which includes a full assessment, plan of care, and clinical documentation.

• Initial Evaluation Fee: $200
• This evaluation is required in addition to the first month's treatment plan.

Total Due at Enrollment:

• Initial Evaluation ($200) + First Month Membership ($350) = $550 total due at the beginning of the program

2. Payment Terms

1. The Client authorizes automatic monthly payments of $350 to be charged on the same calendar date as initial enrollment.
2. Payment is due in full at the beginning of each billing cycle.
3. No roll-over of unused sessions is permitted. Missed or canceled sessions are forfeited.
4. The Client must provide 30 days' written notice for membership cancellation. Cancellation becomes effective at the end of the notice period.
5. All fees are non-refundable once payment has been processed.
6. Payment failures or declined transactions may result in suspension of scheduling privileges until the balance is cleared.

3. Session Policy

1. Each therapy session lasts forty-five (45) minutes.
2. Appointments are scheduled in advance and are subject to therapist availability.
3. Cancellations require a minimum of 24 hours' notice.

• Sessions canceled or missed without 24-hour notice will be forfeited and a late fee will be charged ($45).

4. Late arrivals do not extend the session time.
5. The Provider reserves the right to reschedule sessions due to emergencies or therapist unavailability with reasonable notice to the Client.

4. Optional Add-On Services

A. Dry Needling Add-On Plan

• $180 per month for 4 sessions (1x/week or per therapist's discretion; may extend up to two weeks or longer from previous treatment).
• Discounted from $55 per session.
• Must be selected at the start of the month; cannot be prorated or carried over.
• Client initials if choosing this add-on: _________

B. Ultrasound-Guided Dry Needling (per the discretion of the provider for precision if required).

C. Spinal Manipulation (included in sessions if required as a treatment per therapist discretion)

5. Additional Visit Policy

If the therapist determines, based on medical necessity or treatment complexity, that the Client requires two (2) visits per week, an additional $60 fee will apply for the second visit. The Client will be notified prior to scheduling.

6. Documentation Policy

Under this membership plan, 3A's Physical Therapy does not complete:

• FMLA forms
• Disability forms
• Workers' compensation paperwork
• Other medical-legal or insurance documentation

Clients requiring these documents should consult their primary care provider or referring physician.

7. Communication and Consent

1. The Client agrees to disclose all relevant medical history and changes in condition.
2. The Client consents to receive communications (texts, calls, or emails) for appointment reminders, updates, or billing notifications.
3. The Client acknowledges that all therapeutic interventions may include manual therapy, exercise, or other evidence-based physical therapy techniques, as appropriate.

8. HIPAA Privacy and Confidentiality Statement

3A's Physical Therapy, PLLC complies fully with the Health Insurance Portability and Accountability Act (HIPAA).

• All client information, health data, and session details are confidential and will only be disclosed as required by law or with the Client's written consent.
• Records are securely stored and accessible only to authorized personnel involved in the Client's care.
• Clients have the right to access their records and request corrections in writing.

By signing this Agreement, the Client acknowledges receipt of 3A's Physical Therapy's Notice of Privacy Practices and agrees to the use and disclosure of health information as outlined.

9. Credit/Debit Card Authorization

By signing below, the Client authorizes 3A's Physical Therapy, PLLC to charge the payment method provided for:

• The recurring monthly membership fee of $350; and
• Any selected add-on services or additional visits, as agreed upon and documented.

This authorization remains valid until the membership is canceled in writing and the 30-day notice period is fulfilled. The Client agrees to update payment information promptly upon expiration or change of card.

Initials: _________

10. Liability Waiver and Acknowledgment

1. The Client understands that results from therapy may vary and that participation involves certain inherent risks, including temporary soreness or discomfort.
2. The Provider and its employees shall not be held liable for injury, loss, or damages arising from treatment except in cases of proven negligence or willful misconduct.
3. This Agreement is not a substitute for medical insurance and cannot be billed or reimbursed through health insurance plans.

11. Termination of Agreement

The Provider reserves the right to terminate this Agreement for:

• Repeated missed appointments;
• Non-payment; or
• Behavior deemed unsafe or inappropriate toward staff.

No refunds will be issued for partial months upon termination.

12. Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of Texas, without regard to its conflict of law principles.

13. Entire Agreement

This document constitutes the entire agreement between the Provider and the Client. Any amendments or modifications must be made in writing and signed by both parties.

Client Acknowledgement

By signing below, I confirm that I have read, understood, and agree to all terms and conditions of this Membership Agreement, including payment terms, policies, and consent provisions.

Terms of Service