MONTHLY DISCOUNTED MEMBERSHIP PLAN AGREEMENT
WEEKLY PAYROLL DEDUCTION MEMBERSHIP PLAN
One Full-Service Appointment per month. You will be deducted $5 each week from your Payroll. Any additional visits will be purchased for a discounted rate of $30/visit. Visits can be shared with immediate family members (spouse/partner or children Each month, any unused visits will expire.
INDIVIDUAL'S FINANCIAL RESPONSIBILITY AND TERMS
- I understand that I am financially responsible for this chiropractic membership plan.
- I authorize Happy Spine Chiropractic and/or Prime Inc. to charge my payroll each week $5 to pay for my discounted membership plan.
- Any additional visits can be purchased for a discounted rate of $30/visit.
- I understand that Happy Spine Chiropractic does not file any insurance, and I am responsible for my treatments/visits.
- I understand that Dr. Marcel Popa, DC (Happy Spine Chiropractic) is a non-participating physician with Medicare and Medicaid and thus is an out-of-network provider.
- I am aware that treatments related to a Personal Injury case are higher than the Discounted Membership Prime rates. In this case, my treatments will be charged per procedure, and not at a discounted rate, therefore my Discounted Membership Plan will not apply.