Office Policies
Questions about any of the below? Contact us and we'd be happy to help.
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Intake Form Policy
All patients must have a completed New Patient Intake Form on file before being treated by Dr. Chu. If you arrive for your appointment and this has not been completed, we will provide a laptop for you to fill it out ahead of your session.
Cancellation Policy
We ask for 24-hours' notice, otherwise we'll charge the full price of the session (or deduct a session from your package, if applicable).
Any cancellations received on Sunday via info@activateperformance.com or (628) 388-9022 will be processed first thing on Monday morning and will be treated as 24-hours' notice.
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If you're sick or showing COVID symptoms, or if there are other extenuating circumstances, please contact us (info@activateperformance.com or (628) 388-9022) so we can find the best solution to keep you and our team safe.
Late Arrival Policy
Please contact us (info@activateperformance.com or (628) 388-9022) if you know you are running late. We will call patients who are running 5+ minutes late.
For 20-minute sessions, if you are more than 10 minutes late you need to reschedule your session and will be charged a cancellation fee equal to the cost of the session (or deduct a session from your package, if applicable).
For 40+ minute sessions, if you are more than 10 minutes late you will pay the full price of the session (no pro-rating for missed time).
No-Show Policy
No-shows, like last-minute cancellations, leave a gap the chiropractor's day that could have been used to help another patient. They will be charged a cancellation fee equal to the cost of the session (or deduct a session from your package, if applicable).
Mask Policy
Patients are no longer required to wear masks, but we do offer them if you'd like to wear one. If you're getting over a cold or have other illness concerns, please wear a KN95 or N95 mask for your safety and the safety of our team.
Individual Packages & Family Pricing
Packages of 10 and 20 x 20-minute sessions are only available for individuals given limitations in our booking software. Packages can't be applied toward a New Patient Visit.
Families who would like to pre-pay and take advantage of a discount should contact us or speak with the front office staff to make arrangements.
Office Contact Information
Now that our Activate Performance team is fully-staffed, we ask that you please contact us directly at info@activateperformance.com or (628) 388-9022 for bookings, updates, or any other patient needs (rather than reaching out to Dr. Chu directly). This will help ensure you can get timely support, as well as allow Dr. Chu to focus on her patients.
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Service Policy
We reserve the right to refuse service to anyone.
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Accuracy of Information
To the best of your knowledge, the information you provide us is true and correct. You understand that providing incorrect information can be dangerous to your health. It is your responsibility to inform the office of any changes in medical status.
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Privacy and Sharing of Information (HIPPA)
You authorize the clinic and its associated health professionals to collect your personal and medical information as documented above. In addition, you authorize the clinic and its associated health professionals to communicate with your family doctor and/or referring doctor as deemed necessary for your beneficial treatment. You also understand that your personal and medical information is confidential and will only be disclosed to third parties with your permission. You understand that the New Patient Intake Form will be placed in your chart for 7 years.
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Medicare
We are non-participating providers for Medicare. This means you pay us in full at the time of service. We then will bill Medicare for your adjustment and Medicare will reimburse you directly. Medicare will not reimburse you for exams, consultations, imaging, rehabilitation, wellness treatments, massage, supports or supplies. They will only reimburse you for acute treatment adjustments they feel are medically necessary.
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Payment and Fees
Payment is due at the time of service unless other arrangements have been made. We accept every major credit card, HSA/FSA debit cards, and cash. If your account is not paid within 7 days from the date of service and no financial arrangements have been made, you may be held responsible for legal fees, collection agency fees, and expenses incurred in collecting your amount. Any returned checks will be assessed a $30 processing fee along with the amount of the check.
The fee for emergency, after-hours, and holiday visits in the office is 1.5 times the treatment fee unless otherwise agreed upon. Treatments at your home are 2 times the treatment fee unless otherwise agreed upon.
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Insurances and Request of Superbills
We are considered an out-of-network chiropractic clinic. The treatments given to you are dictated by what the doctor deems best for you, not what insurance companies dictate is best for you. This means that we do not participate in taking insurance and that you are required to pay at the time of service.
If your insurance company accepts out-of-network providers, you can request a Superbill. You are responsible for asking our office for a Superbill and providing the Superbill(s) to your insurance company for reimbursement.
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Authorization of Health Information For a Special Purpose
It is our desire for our staff to post patient testimonials on our website, newsletter, social media, and in the office where people can read about your personal experience of chiropractic care and how it has helped you. These testimonials may include your name, details, of your specific case, photo or video, and the reason(s) why you came in our office for treatment. Testimonials are only collected and used from patients who freely choose to share their experiences in our office with others.
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Participation in Teamwork
Your chiropractor took an oath to do their best to treat your condition(s). You understand that your chiropractor will do everything in their power to achieve your health goals. You also understand that the best results come from the combination of good work from the doctor and yourself.
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Authorization to Enter Building
The building is under video surveillance 24/7 and considers who enters the property seriously. Please honor this by using the access code given to you for appointments with Dr. Chu, D.C. at Activate Performance only.
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Informed Consent to Care
You are the decision maker for your health care. Part of our role is to provide you with information to assist you in making informed choices. This process is often referred to as “informed consent” and involves your understanding and agreement regarding the care we recommend, the benefits and risks associated with the care, alternatives, and the potential effect on your health if you choose not to receive the care.
We may conduct some diagnostic or examination procedures if indicated. Any examinations or tests conducted will be carefully performed but may be uncomfortable. Chiropractic care centrally involves what is known as a chiropractic adjustment. There may be additional supportive procedures or recommendations as well.
When providing an adjustment, we use our hands or an instrument to reposition anatomical structures, such as vertebrae. Potential benefits of an adjustment include restoring normal joint motion, reducing swelling and inflammation in a joint, reducing pain in the joint, and improving neurological functioning and overall well-being.
It is important that you understand, as with all health care approaches, results are not guaranteed, and there is no promise to cure. As with all types of health care interventions, there are some risks to care, including, but not limited to: muscle spasms, aggravating and/or temporary increase in symptoms, lack of improvement of symptoms, burns and/or scarring from electrical stimulation and from hot or cold therapies, including but not limited to hot packs and ice, fractures (broken bones), disc injuries, strokes, dislocations, strains, and sprains.
With respect to strokes, there is a rare but serious condition known as an “arterial dissection” that typically is caused by a tear in the inner layer of the artery that may cause the development of a thrombus (clot) with the potential to lead to a stroke. The best available scientific evidence supports the understanding that chiropractic adjustment does not cause a dissection in a normal, healthy artery. Disease processes, genetic disorders, medications, and vessel abnormalities may cause an artery to be more susceptible to dissection. Strokes caused by arterial dissections have been associated with over 72 everyday activities such as sneezing, driving, and playing tennis.
Arterial dissections occur in 3-4 of every 100,000 people whether they are receiving health care or not. Patients who experience this condition often, but not always, present to their medical doctor or chiropractor with neck pain and headache. Unfortunately a percentage of these patients will experience a stroke.
The reported association between chiropractic visits and stroke is exceedingly rare and is estimated to be related in one in one million to one in two million cervical adjustments. For comparison, the incidence of hospital admission attributed to aspirin use from major GI events of the entire (upper and lower) GI tract was 1219 events/ per one million persons/year and risk of death has been estimated as 104 per one million users.
It is also important that you understand there are treatment options available for your condition other than chiropractic procedures. Likely, you have tried many of these approaches already. These options may include, but are not limited to: self-administered care, over-the-counter pain relievers, physical measures and rest, medical care with prescription drugs, physical therapy, bracing, injections, and surgery.
Lastly, you have the right to a second opinion and to secure other opinions about your circumstances and health care as you see fit.