Service Agreement

2. Insurance: It is the responsibility of the client/parent/guardian to inform St Croix Therapy of all changes in insurance information, including group policy number, phone numbers, etc. Failure to do this could result in total client responsibility for charges incurred. As a personal service to you, we contact your insurance company for plan benefits. Note: Although benefits may be available under your plan, there are no guarantees of insurance payment; therefore, all services rendered are the responsibility of the client/parent/guardian.

3. Treatment plans: An agreement has been made between the therapist and the client/parent/guardian regarding the frequency of therapy, which has been determined to maximize the therapeutic effect of treatment.

4. Appointment Attendance: Please see the “Appointment Attendance Policy.”

5. Pick-up times: It is a courtesy of St Croix Therapy to allow parents/guardians/caregivers to leave the premises during the client’s appointment. However, it is very important to be back on the premises 10 minutes before the appointment is scheduled to end so the therapist can discuss treatment.

6. Emergencies and general contact: If an emergency should occur during treatment, the therapist should know how to contact the parent/ guardian/caregiver by telephone. St Croix Therapy also asks the client/parent/guardian/caregiver to provide a daytime telephone number for general notification purposes.

7. St Croix Therapy provides the following additional facility and health-related services: Tours of the facility during treatment hours to prospective clients, vendors, physicians, employee candidates, and therapy students. Since St Croix Therapy is a teaching clinic, therapy students may also participate in a client's treatment session under the supervision of a St Croix Therapy therapist. Client’s family members or caregivers may view evaluation or treatment sessions. Communication with client/parent/guardian/caregiver via telephone, voicemail, email, and postal service. Communication with school therapists and staff via telephone, voicemail, email, and postal service.

8. Questions/Concerns: Any questions, concerns or problems with services provided by St Croix Therapy should be directed to the Executive Director. As providers, we appreciate your input whether it is in the form of feedback.

By signing below, acknowledges receipt of the above information and the associated policies where applicable.