Financial Policy
Thank you for your interest in choosing Avon Therapeutic Center for
Children, LLC. The following is a statement of our financial policy which
we require that you read and understand prior to your consultation.
Please call the Center to obtain a full and updated copy of the Financial
Policy Agreement.
The Initial Consultation includes a review of past medical records,
questionnaire, current medical problems, physical exam, review of
diagnostic, treatment options and summary report. The visit normally
takes about 3 hours.
In scheduling an appointment, a non-refundable $240 Scheduling Fee is
required. This amount will be applied to your Initial Consultation Fee.
All New Patients must complete and send the following forms at least 10
days prior to their scheduled appointment:
(1) Patient Registration Form
(2) Autism Questionnaire
(3) Financial Policy Agreement - p.3
(4) Informed Consent Form
(5) Medical records (including Vaccination records, if applicable)
(6) $240 Deposit Fee - This will be applied to your Initial Consultation fee.
The Autism Questionnaire is a 27-page document in Adobe Acrobat pdf.
format; it is important to complete this form in order to provide maximum
information to the physician.
Please submit these forms promptly so that time will be maxi-
mized during the patient's scheduled appointment.
Cancellation Policy: All cancellations must be done at least 5 business
days prior to the scheduled appointment. The Deposit Fee of $240 will be
mailed back to you in 2-4 weeks. Should you decide to cancel the appoint-
ment within 5 business days, the Deposit Fee will be forfeited. The $240
Scheduling Fee is non-refundable.
Rescheduling Policy: Rescheduling of appointment must be done no
later than 10 business days prior to the scheduled appointment. Should
you decide to reschedule within 10 business days to your scheduled
appointment, a new $240 Scheduling Fee will be required.
Date of rescheduled appointment is dependent on availability and must
be scheduled to a date within 3 months of original schedule. If the re-
scheduled appointment is again postponed for whatever reason, a new
scheduling fee will apply.
Follow-up Visits include a review of laboratory data, interval history,
physical exam when indicated, review of diagnostic treatment options
and a summary report. These regular visits normally run about an hour.
After the 1st hour, the patient will be billed in 15-minute increments.
Please note that Avon Therapeutic Center does NOT participate
with any insurance company. We do not file or accept insurance.
Full payment is expected at the time of service. We accept cash,
personal check, Cashier’s Check, Money Order, Visa, MasterCard.
A service charge will apply for checks returned from your bank.
Credit Card Policy: For keyed-in credit card transactions only, a handling
fee will apply. This handling fee is waived for the nonrefundable Scheduling
Fee and for the Deposit Fee. (This handling fee is necessary to offset bank
fees the bankcard charges for keyed-in transactions.)
Laboratory fees are not included in our fees. Avon Therapeutic
Center for Children, LLC is not affiliated with the special laboratories
(such as Great Smokies Lab, Immunolab, etc) and do not profit from the
use of their services. Payments for laboratory services are made directly
to the laboratory. Please direct payment questions to them.
Phone consultations for follow-up visits are welcomed. This will be
very convenient for long-distance travelers. It will also be billed at our
standard hourly rate. Phone consultations are not advisable for Initial
Consultations.
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