30212 Tomas, Suite 120 Rancho Santa Margarita, CA
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It is our goal to provide our patients with the highest quality of care while also attempting to accommodate our patients’ schedules for their convenience. Therefore, we provide reserved time slots for each patient in order to minimize our patients’ waiting time and assure continuity of treatment. Your consistent attendance of the planned treatment regimen is an important factor in your recovery.
While we are sensitive to the fact that emergencies may occur in rare instances, cancellations [especially those which are last minute] and missed appointments decrease our ability to accommodate the scheduling needs of other patients. Therefore, we require that our patients comply with the Cancellation and Missed Appointment Policy:
If you cancel a scheduled appointment less than twenty-four (24) hours prior to the scheduled appointment time, or if you do not arrive to the appointment at all, it will be considered a “missed appointment” and you will be charged a Missed Appointment Fee of $50.00;
I hereby request and consent to the performance of various modes of physical therapy on me (or the patient named below, for who I am legally responsible) by Focus Physical Therapy and/or other licensed physical therapists working at the clinic. I further acknowledge that no guarantees or assurances have been made to me concerning the results intended from the treatments. I intend this consent form to cover the entire course of treatment of my present condition and for any future condition(s) for which I seek treatment. I understand that I may refuse treatment at any time and that I am responsible for my healthcare choices.
The office of Focus Physical Therapy is committed to upholding the security and confidentiality of personal information that you provide to us. We take responsibility of safeguarding your information very seriously. We do not share or sell patient information with anyone outside our office without your written consent. This policy covers information including personal, financial, or health information about a consumer or customer relationship.
Your form has been submitted. All information received will always remain confidential. We will contact you as soon as we review your form.