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Payment Policy for Kina Wellness: Thank you for choosing Kina Wellness for your healthcare needs. To ensure a smooth and efficient experience for both our patients and staff, we have implemented the following payment policy for new patient appointments: 1. Payment Requirement: Payment for all new patient appointments is due at the time of booking. This includes the initial consultation fee and any additional charges for services rendered during the appointment. Payment for follow-up appointments will be billed the same day after the appointment to the credit card on file. 2. Accepted Payment Methods: We accept various forms of payment, including credit/debit cards, venmo, and cash. Please ensure that your preferred payment method is readily available when booking. 3. Booking Confirmation: Your appointment will be confirmed upon receipt of payment. Once payment is processed, you will receive a confirmation email or text message containing details of your appointment along with any necessary instructions. 4. Cancellation and Refund Policy: We understand that unforeseen circumstances may arise causing the need to reschedule or cancel appointments. However, please note that payments for new patient appointments are non-refundable. If you need to reschedule your appointment, please contact us at least 24 hours in advance to avoid forfeiture of payment. 5. Late Arrivals: We strive to maintain a punctual schedule to accommodate all our patients. If you arrive late for your appointment, please understand that your appointment time may be shortened to avoid inconvenience to other patients. However, the full appointment fee will still apply. 6. Insurance and Reimbursement: Please be advised that Kina Wellness does not directly bill insurance companies for new patient appointments. However, upon request, we can provide you with a detailed receipt containing all the necessary information for you to seek reimbursement from your insurance provider. 7. Additional Charges: Any additional services or treatments recommended during your appointment will incur additional charges. These charges will be discussed with you prior to implementation, and payment will be required before services are rendered. 8. Confidentiality: Rest assured that all payment information provided to Kina Wellness is kept strictly confidential and is securely processed in accordance with industry standards. By booking a new patient appointment with Kina Wellness, you agree to abide by the terms outlined in this payment policy. If you have any questions or concerns regarding payment or any other aspect of your appointment, please feel free to contact us. Thank you for your understanding and cooperation. Sincerely, Kina Wellness

Membership Payment and Cancellation Policy 1. **Purpose** This policy outlines the guidelines and procedures for membership payments, renewals, and cancellations to ensure transparency and fairness for all members. #### 2. **Membership Payment** ##### 2.1 **Payment Methods** - **Online Payment:** Members can pay their membership fees via our secure online payment portal using credit/debit cards, electronic bank transfers, or digital wallets. - **Recurring Payments:** Members may opt for automatic recurring payments to ensure continuous membership. ##### 2.2 **Payment Schedule** - **Annual Membership:** Payment is due in full on the anniversary date of the initial membership. - **Monthly Membership:** Payment is due on the first day of each month. - **Grace Period:** A grace period of 10 days is provided for all payments. After this period, a late fee of 5% of the membership fee will be applied. ##### 2.3 **Discounts and Promotions** - **Referral Discount:** Members who refer a new member will receive a $25 discount on their next renewal or visit. - **Promotional Offers:** Periodic promotions may offer discounts or benefits, which will be communicated via official channels. #### 3. **Membership Cancellation** ##### 3.1 **Cancellation by Member** - **Notice:** Members must provide written notice of cancellation at least 30 days before the desired cancellation date. - **Refund Policy:** Refunds will be processed as follows: - **Monthly Membership:** No refunds will be issued for monthly memberships. ##### 3.2 **Cancellation by Organization** - **Non-Payment:** Membership will be automatically canceled unless payment is received within 30 days after the due date. - **Violation of Policies:** Membership may be cancelled without refund if a member violates the organization's code of conduct or other policies. - **Notification:** Members will be notified in writing of the cancellation and the reasons for it. ##### 3.3 **Reactivation** - **Request for Reactivation:** Cancelled memberships can be reactivated within 3 months of cancellation by paying any outstanding dues and a reactivation fee of $50. - **New Membership:** After 6 3onths, a canceled member must reapply for membership as a new member. #### 4. **Dispute Resolution** - **Initial Resolution:** Members should first attempt to resolve any payment or cancellation disputes with the membership services department. - **Formal Appeal:** If unresolved, a formal appeal can be submitted in writing to the Membership Committee, which will review the case and provide a final decision within 30 days. #### 5. **Communication** - **Updates:** Members will be informed of any changes to this policy via email and updates on the organization's website. - **Support:** For questions or assistance regarding membership payments and cancellations, members can contact the support team at [support email] or call [support phone number]. #### 6. **Effective Date** This policy is effective as of [Effective Date] and will remain in effect until further notice. By following this policy, we aim to provide a clear and fair process for managing membership payments and cancellations, ensuring a positive experience for all our members.

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Office Policies for a Functional Medicine Practice

1. Appointment Scheduling and Cancellations


  • Appointments can be scheduled via phone, online booking system, or in person at the office.

  • New patient appointments require a completed intake form and relevant medical history documentation submitted at least 48 hours before the appointment.

  • New Patient appointments are to be paid for within 24 hours, and prior to the appointment.

Cancellations and Rescheduling:

  • Cancellations must be made at least 24 hours before the scheduled appointment to avoid a cancellation fee.

  • Missed appointments or late cancellations (less than 24 hours’ notice) will incur a fee of $50.

  • Repeated cancellations or no-shows may result in the patient being required to prepay for future appointments.

2. Office Hours and Communication

Office Hours:

  • The practice is open Monday, Wednesday, Thursday’s, and Friday’s hours vary.

  • Limited appointments are available on Saturdays from 9:00 AM to 1:00 PM.


  • Non-urgent questions can be addressed via our patient portal or email, with a response time of 24-48 hours.

  • For urgent concerns, please call the office directly. In case of a medical emergency, dial 911 or go to the nearest emergency room.

3. Payment and Insurance


  • Payment is due at the time of service unless prior arrangements have been made.

  • We accept cash, credit cards, and venmo.

  • Insurance:

  • We are an out-of-network provider and do not bill insurance directly. Patients will be provided with a detailed receipt (superbill) to submit to their insurance for reimbursement upon request.

  • It is the patient’s responsibility to verify their insurance benefits and coverage for out-of-network providers.

4. Confidentiality and Privacy

  • All patient information is kept confidential in accordance with HIPAA regulations.

  • Patients have the right to access their medical records upon request. A written request is required, and copies will be provided within 7-10 business days.

5. Treatment Plans and Follow-ups

Initial Consultation:

  • The initial consultation includes a comprehensive review of medical history, lifestyle, and current symptoms. This appointment typically lasts 60-90 minutes.

Follow-up Visits:

  • Follow-up visits will be scheduled as needed based on the individualized treatment plan. These appointments typically last 30-60 minutes.

Treatment Compliance:

  • Patients are expected to follow the treatment plan as agreed upon. Non-compliance may result in the reassessment of the treatment plan or discontinuation of care.

6. Laboratory Tests and Supplements

Laboratory Tests:

  • Specific laboratory tests may be recommended as part of your treatment plan. Patients are responsible for the cost of these tests, which may be billed directly by the laboratory.


  • The practice may recommend supplements as part of the treatment plan. While patients are free to purchase supplements from any source, the practice offers high-quality supplements for convenience.

7. Patient Responsibilities

  • Provide accurate and complete health information.

  • Follow the agreed-upon treatment plan and inform the practitioner of any changes in health status.

  • Communicate openly about any concerns or questions regarding treatment.

  • Respect office staff and other patients by adhering to office policies and maintaining a courteous environment.

8. Infection Control and Safety

  • Patients with symptoms of contagious illnesses are asked to reschedule their appointments to prevent the spread of infection.

  • The office adheres to stringent cleaning and sanitization protocols to ensure a safe environment for all patients and staff.

  • Hand sanitizers and masks are available at the office entrance. Patients are encouraged to use them upon entering the facility.

9. Telemedicine

  • Telemedicine appointments are available for patients who prefer remote consultations or cannot visit the office in person.

  • Telemedicine appointments must be scheduled in advance and require a stable internet connection and access to the necessary technology (computer, tablet, or smartphone).

10. Feedback and Grievances

  • Patient feedback is valued and can be provided through our patient portal, suggestion box in the office, or via email.

  • Any grievances or complaints will be addressed promptly. Patients are encouraged to report any concerns to the office manager or directly to their practitioner via email or patient portal.

These policies are designed to ensure a smooth, respectful, and efficient experience for both patients and staff. Thank you for choosing our functional medicine practice for your healthcare needs.

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