Payment:

Payment is expected at the time of your appointment. Fees are accepted in the form of cash, check, venmo or major credit cards, prior to the start of the visit. Please make checks payable to Karen Louise Scheuner. You may also pay with credit card on the website, www.mindful-nutrition.com. There is a fee if you pay with credit card. If there is any difficulty in making payment at the time of the visit, please negotiate this with her at the time of the initial interview. 

Cancellation Policy:

Individual appointments are scheduled for a specific time. You will be charged the full fee for missed individual appointments unless Karen is notified of cancellation at least 24 hours in advance, or in cases of emergency. Missed appointment fees should be paid at the time of your next appointment. Please do not use email to cancel or reschedule an appointment unless it is more than 48 hours from the originally scheduled appointment. Parents or legal guardians are legally responsible for all fees of clients under the age of 18. It is the parent/guardian’s responsibility to ensure that the appointment is kept or cancelled. Last minute cancelations and ‘no show’ appointments will be charged the agreed upon fee to your credit card; information provided below. 

Confidentiality:

All information disclosed within sessions is confidential as outlined in the HIPAA notice of Privacy Practices. 

Medical Insurance:

Medical insurance companies may or may not offer coverage for medical nutrition therapy. Carefully investigate the type of coverage you have. It is your responsibility to pay for your visit and to have your insurance company reimburse you if applicable.

You will be provided with a receipt “super bill” that you can submit to your insurance company for reimbursement. Please check with your insurance to inquire on co-pay for nutrition services. 


I have read and understand the above information

Name *
Name
Entering your name here is equivalent to your digital signature. Sign by Parent/Guardian if under 18.
Date *
Date
Credit Card is held on file for no-show's or cancellations
Credit Card Expiration
Credit Card Expiration