Free Chiropractic Clinic Contract Template

Chiropractic Clinic Contract

Agreement

This Chiropractic Clinic Contract (“Agreement”) is entered into on [insert date] between [Your Company Name], located at [Your Company Address] (“Clinic”), and [Client Name], residing at [insert address] (“Client”). This Agreement outlines the terms and conditions under which [Your Company Name] shall provide chiropractic services to the Client. By signing this Agreement, both parties agree to adhere to the terms, conditions, and responsibilities defined within this document. It is the intention of the Clinic and Client to establish a clear and effective partnership to achieve optimal health outcomes for the Client through chiropractic care.

I. Definitions

A. Chiropractic Services

  1. Chiropractic services refer to health care techniques designed to correct physical alignment, relieve pain, and improve mobility using manual manipulation, spinal adjustments, and other therapeutic interventions. Chiropractic care is an essential aspect of preventive health care, with the goal of enhancing the body’s natural ability to heal itself by focusing on the spine and nervous system.

  2. Such services include, but are not limited to, spinal adjustments, physical therapy, soft tissue therapy, and wellness consultations. These services are designed to address a range of musculoskeletal conditions, including back pain, neck pain, headaches, and joint issues. Chiropractic care can also support injury rehabilitation and overall health maintenance.

  3. Chiropractic treatments are personalized and will be tailored to the Client’s specific health concerns, including posture correction, injury rehabilitation, and chronic pain management. The Clinic will perform a comprehensive assessment to determine the most appropriate treatment plan for the Client, ensuring that all interventions are suited to their specific needs.

B. Client

  1. The term "Client" refers to the individual seeking chiropractic care under this Agreement. The Client, by entering into this contract, acknowledges the desire for improved health and well-being through chiropractic care.

  2. The Client acknowledges that they have provided accurate and complete medical history to facilitate effective care. Failure to provide accurate information may affect the treatment plan and outcomes. The Clinic reserves the right to adjust or modify the treatment plan if discrepancies in the Client’s medical history are discovered.

  3. The Client agrees to communicate any new or evolving medical conditions or symptoms that may affect their chiropractic care throughout the duration of treatment. Any changes in health conditions will be considered during treatment adjustments to ensure safe and effective care.

C. Clinic

  1. The "Clinic" refers to [Your Company Name], including all employees, contractors, and representatives providing chiropractic services.

  2. The Clinic guarantees that all care provided will be rendered in a professional manner by licensed chiropractors who are trained in the appropriate therapeutic techniques and treatments. The Clinic maintains a high standard of care, ensuring all staff are up-to-date with the latest practices and guidelines in the field of chiropractic care.

  3. The Clinic commits to providing a comfortable, clean, and safe environment for all Clients. The Clinic will also ensure that all equipment used during chiropractic treatments is regularly maintained and up to industry standards.

II. Scope of Services

A. Service Inclusions

  1. [Your Company Name] agrees to provide chiropractic services as needed, including but not limited to:

    • Initial Consultation: A thorough health assessment to understand the Client’s medical history, current health concerns, and wellness goals. This initial consultation is an essential first step in establishing a treatment plan that best suits the Client’s needs. During this consultation, the chiropractor will conduct a physical examination, including a postural and range of motion evaluation.

    • Spinal Manipulation: This includes manual spinal adjustments aimed at improving the alignment of the spine, relieving pain, reducing muscle tension, and improving overall function. The chiropractor will carefully tailor each adjustment to suit the Client's specific condition and pain level.

    • Soft Tissue Therapy: Techniques such as massage therapy and myofascial release to address muscle imbalances, stiffness, and pain. Soft tissue therapy may also include trigger point therapy, which helps to release tension and improve blood circulation in the muscles.

    • Rehabilitation Exercises: A set of personalized exercises designed to strengthen muscles, improve flexibility, and prevent future injuries. These exercises will be prescribed to enhance the effectiveness of chiropractic care and will be adjusted as needed based on the Client’s progress.

    • Postural Correction: Recommendations and exercises aimed at improving posture, reducing strain on the body, and enhancing movement efficiency. Postural correction may include ergonomic assessments to help the Client modify their daily routines and environment to promote better spinal health.

    • Follow-Up Sessions: Routine check-ups to monitor the Client’s progress, make adjustments to the treatment plan, and offer ongoing support for long-term health. These sessions may involve reassessing the Client’s progress, adjusting spinal manipulations, and providing additional exercises or lifestyle changes.

  2. The Clinic will provide ongoing care and support throughout the treatment period, with flexibility to adjust the care plan based on the Client’s evolving needs. The frequency of visits and the course of treatment will be evaluated regularly, and adjustments will be made in alignment with the Client’s progress and response to therapy.

B. Exclusions

  1. Services outside the expertise of the Clinic, including medical diagnostics or treatments unrelated to chiropractic care, will not be included in this Agreement.

  2. The Clinic does not provide emergency medical services or surgeries. Any emergency medical needs will be referred to the appropriate healthcare provider. In cases of severe or acute injury, the Client will be advised to seek immediate medical attention from an emergency room or urgent care facility.

  3. If the Client requires medical interventions beyond chiropractic care, such as diagnostic imaging or prescription medications, the Clinic will provide a referral to the appropriate medical professionals.

III. Payment Terms

A. Service Fees

  1. The Client agrees to pay the following fees for chiropractic services:

    • Initial Consultation: $[150]

    • Chiropractic Session: $[90] per session. This rate applies to standard 30-minute chiropractic adjustments.

    • Follow-Up Consultation: $[80]

    • Custom Therapy Plan: $[200-$500], depending on the complexity of the treatment plan and the number of sessions required. Complex cases such as long-term rehabilitation may fall on the higher end of the fee range.

  2. A 10% discount may be applied if the Client pre-pays for a package of [10] sessions in advance. This discount offers a cost-effective solution for Clients who are committed to completing a series of treatments over time. The discount will be applied to the total cost at the time of booking.

  3. Payment for each service is due upon booking or at the time of service. The Clinic reserves the right to suspend treatment if payments are not made in a timely manner.

B. Payment Methods

  1. The Clinic accepts the following payment methods for services rendered:

    • Credit or Debit Cards (Visa, MasterCard, American Express)

    • Cash

    • Online transfers via [Your Company Website]

  2. The Clinic will provide a receipt for each payment transaction, which includes a detailed breakdown of the services provided and the total fee. The receipt will also include the Client’s name, date of service, and any applicable discounts or promotions.

C. Refunds

  1. Refunds for prepaid sessions may be issued under the following conditions:

    • A written cancellation notice is received at least [72] hours in advance. Cancellations made with less than [72] hours' notice will incur a cancellation fee of $[50].

    • Services not rendered due to unforeseen circumstances caused by the Clinic, such as an appointment cancellation by the Clinic.

    • The Client is entitled to a full refund if the Clinic is unable to accommodate the Client’s preferred schedule due to availability issues.

  2. In the event of a refund, the Clinic will process the refund within [15] business days of receiving the request. A processing fee of $[25] may be applied for refund requests made after the session has occurred.

IV. Client Responsibilities

A. Accurate Information

  1. The Client must provide accurate and complete medical and personal information during initial consultations and subsequent visits. This includes a detailed medical history, current health status, medications, and previous injuries. The Clinic may ask the Client to update their medical information periodically, particularly if any changes in health conditions or medication occur during the course of treatment.

  2. The Client agrees to inform the Clinic of any changes in their health status, including new symptoms or conditions that may arise during the course of treatment. Failure to provide updated health information may hinder the effectiveness of treatment.

B. Attendance

  1. The Client is responsible for attending all scheduled sessions. If a session is missed, the Client must notify the Clinic at least [24] hours prior to the scheduled appointment to avoid a cancellation fee.

  2. A missed appointment without prior notice may incur a charge of $[50] to cover administrative costs. Repeated missed appointments may result in the suspension of treatment services or termination of the contract.

C. Compliance with Care Plans

  1. The Client agrees to follow the prescribed care plan, which includes attending all sessions, completing at-home exercises, and following any lifestyle recommendations made by the Chiropractor. Compliance with the treatment plan is essential for achieving the best possible results and ensuring that the Client’s condition improves in a safe and timely manner.

  2. Failure to comply with the prescribed treatment plan may result in slower progress or ineffective results. The Clinic will review the Client’s progress regularly and will adjust the treatment plan if necessary, but the Client must remain committed to the treatment process.

V. Clinic Responsibilities

A. Professional Standards

  1. [Your Company Name] will ensure that all chiropractic services are provided by licensed chiropractors who have completed the necessary training and certification requirements in accordance with local regulations. The Chiropractors will adhere to the highest standards of practice in the chiropractic profession and engage in continuing education to maintain their licenses and expertise.

  2. The Clinic will maintain a high standard of care, using the latest chiropractic techniques, equipment, and methods to ensure the best possible outcomes for the Client. The Clinic is committed to improving the health and well-being of its Clients by staying at the forefront of chiropractic research and technology.

B. Confidentiality

  1. The Clinic will maintain the confidentiality of all personal and health-related information provided by the Client in accordance with applicable privacy laws. This information will not be shared with third parties unless required by law or with the Client’s written consent.

  2. Any medical records will be securely stored and protected, and the Client has the right to access these records upon request. The Clinic will only disclose medical information when necessary for treatment purposes or as required by law.

C. Emergency Situations

  1. The Clinic is not equipped to handle medical emergencies. In case of an emergency, the Client will be referred to the appropriate medical facility. The Client agrees to follow the Clinic’s recommendation in case of an emergency, including seeking immediate medical attention from an emergency room or urgent care center.

  2. If a situation arises where immediate care is needed, the Client will be advised to seek medical attention from an urgent care facility or hospital. The Clinic will not be liable for any delays in medical attention or treatment outside the scope of chiropractic care.

VI. Cancellation and Termination

A. Cancellation by the Client

  1. Notice of Cancellation:
    The Client may cancel their contract with [Your Company Name] at any time by providing a written notice of cancellation at least [30] days in advance. This notice must be submitted via email, physical mail, or through the Clinic’s designated communication platform. The notice must contain the Client’s name, account details, and reason for cancellation. Written notice is required to ensure that the cancellation request is properly processed.

    • In the event of cancellation, any remaining unused sessions that were pre-paid will be refunded based on the terms of the Refund Policy outlined in Section III, less any applicable cancellation or administrative fees.

    • If the Client cancels the contract before completing their pre-paid sessions, the Clinic will issue a refund for the remaining balance, which will be calculated based on the number of sessions used. The refund will be processed within [15] business days following the cancellation request.

  2. Cancellation Fee:

    • The Client acknowledges that in the event of early cancellation, a cancellation fee of $[50] may be applied. This fee is intended to cover administrative costs associated with processing the cancellation and re-scheduling of appointments for other Clients.

    • If the Client chooses to cancel a session or appointment with less than [24] hours' notice, a missed appointment fee of $[50] will be charged, which must be paid prior to re-booking any further sessions.

    • The cancellation fee will not apply if the Client can demonstrate that the cancellation was due to a medical emergency or other serious circumstances that prevented attendance. In such cases, the Clinic reserves the right to review and waive the cancellation fee on a case-by-case basis.

  3. Right to Return:

    • The Client has the right to return to [Your Company Name] for chiropractic care after cancellation, subject to availability and the Clinic’s scheduling policies. However, the Client will be required to sign a new Agreement if they wish to continue treatment at a later date. Pricing for any future services will be based on current rates at the time of re-engagement. If any medical conditions have changed since the last treatment, the Client may be asked to undergo a new consultation to reassess the treatment plan.

B. Termination by the Clinic

  1. Grounds for Termination:
    [Your Company Name] reserves the right to terminate the Client’s access to chiropractic services at any time if the Client engages in any of the following behaviors or circumstances:

    • Failure to Comply with Payment Terms: The Client fails to make payments as required under this Agreement, or repeatedly delays payment despite reminders. If payments are overdue for [30] days or more, the Clinic will send a final notice before discontinuing services.

    • Disruptive or Unacceptable Behavior: The Client engages in disruptive, aggressive, or otherwise unacceptable behavior during appointments, including but not limited to verbal or physical abuse toward Clinic staff, other Clients, or visitors. Such behavior will not be tolerated and will lead to immediate termination of services.

    • Non-Compliance with the Treatment Plan: The Client repeatedly refuses to follow or fails to adhere to the agreed-upon chiropractic care plan or therapeutic recommendations. This includes failure to attend scheduled sessions, non-participation in prescribed rehabilitation exercises, or ignoring advice on lifestyle changes, all of which may impede treatment progress.

    • Medical Issues Beyond Scope: If, during the course of treatment, it is discovered that the Client’s condition exceeds the scope of chiropractic care (e.g., requiring surgical intervention or pharmaceutical treatment), the Clinic reserves the right to refer the Client to a more suitable healthcare provider and terminate the chiropractic care relationship.

  2. Termination Procedure:

    • If the Clinic chooses to terminate the Agreement with the Client, a formal written notice will be provided to the Client. This notice will include the reason for termination and, if applicable, any instructions for seeking further medical treatment.

    • In the case of termination due to non-compliance or behavior, the Client may be given a reasonable period to remedy the situation or comply with the treatment plan. However, if the situation remains unresolved, the Clinic will reserve the right to terminate services immediately.

  3. Effect of Termination:

    • Following termination, the Client will no longer be able to access chiropractic services provided by [Your Company Name], unless otherwise agreed to in writing by the Clinic.

    • Any prepaid services will be refunded according to the Refund Policy as outlined in Section III, and the Client will no longer be responsible for future payments related to canceled services. However, any cancellation or administrative fees will still apply.

    • If the Client is terminated due to non-compliance or behavior issues, the Clinic will not be liable for any further services, and the Client will be prohibited from re-booking appointments unless agreed upon by both parties.

VII. Liability

A. Limitation of Liability

  1. Disclaimer of Medical Liability:
    The Clinic offers chiropractic care as a form of complementary healthcare aimed at improving the health and well-being of the Client. While chiropractic care can effectively treat a variety of musculoskeletal conditions, the Client acknowledges that results cannot be guaranteed, and the Clinic makes no representations regarding the ultimate outcome of care.

    • The Clinic does not assume responsibility for injuries or damages caused by pre-existing medical conditions or the failure of the Client to disclose important health information.

    • The Client acknowledges that chiropractic adjustments and other treatments are not without risks. The risks include, but are not limited to, temporary soreness, mild discomfort, or potential aggravation of pre-existing conditions. By signing this Agreement, the Client acknowledges understanding these risks and agrees to proceed with treatment voluntarily.

  2. Indemnification of the Clinic:
    The Client agrees to indemnify and hold harmless [Your Company Name], its chiropractors, staff, affiliates, and any agents acting on behalf of the Clinic, from any and all claims, damages, or expenses arising out of the Client’s actions or failures. This includes:

    • Claims related to conditions or injuries not disclosed to the Clinic before the initiation of treatment.

    • Claims related to any accidents, injuries, or issues arising outside the scope of chiropractic care provided by the Clinic.

    • Any damages resulting from the Client’s failure to follow the recommended treatment plan or to attend sessions in accordance with the care schedule.

  3. No Liability for Consequential Damages:
    [Your Company Name] shall not be liable for any consequential, incidental, or punitive damages arising from the Client’s use of chiropractic services, including but not limited to lost wages, loss of mobility, or any injury unrelated to chiropractic care. The Client’s sole remedy in the event of dissatisfaction with care is a refund or re-treatment, as specified in Section III.

VIII. Dispute Resolution

A. Negotiation

  1. Initial Dispute Resolution:
    In the event of any dispute arising between the Client and [Your Company Name], the parties agree to engage in good faith negotiations to attempt to resolve the matter amicably. The Client and Clinic will each designate a representative to engage in dialogue aimed at reaching a mutually beneficial resolution.

    • The Client must first submit a formal written complaint to the Clinic, outlining the issue, the nature of the dispute, and any potential resolutions. The Clinic will respond in writing within [10] business days, acknowledging the receipt of the complaint and outlining the steps to resolve the issue.

    • Both parties agree to provide all relevant documentation, medical records, and any other materials that may aid in the resolution of the dispute. If an agreeable resolution is reached during negotiations, both parties will sign an addendum to the Agreement to reflect the agreed-upon changes.

  2. Mediation Option:
    If negotiation efforts fail to resolve the dispute within [30] days of the Client’s written complaint, the parties agree to consider mediation as the next step. Mediation will be facilitated by a neutral third-party mediator agreed upon by both the Clinic and the Client.

    • The cost of mediation will be split equally between the Clinic and the Client. The mediator will assist in guiding the discussions, but will not have the authority to impose a binding decision. Both parties will be encouraged to remain open and cooperative throughout the mediation process.

B. Arbitration

  1. Binding Arbitration:
    If mediation is unsuccessful or if the dispute remains unresolved, the parties agree to proceed with binding arbitration as the final step in the dispute resolution process. Arbitration will be conducted under the rules of [insert arbitration body] within [Jurisdiction].

    • The arbitration process will be final and binding on both parties, and any decision made by the arbitrator will be enforceable in a court of law. The arbitration will take place in [Jurisdiction], and all relevant legal procedures for arbitration will be followed.

    • Each party will be responsible for their own legal costs unless the arbitrator rules otherwise. The parties may also be required to bear the arbitration costs, depending on the decision of the arbitrator.

  2. Arbitration Venue and Jurisdiction:

    • The arbitration process will take place in [Jurisdiction], and the laws of [Jurisdiction] will govern the resolution process.

    • If either party fails to comply with the arbitrator’s decision, the other party may seek enforcement of the award through legal proceedings in the relevant courts.

IX. Miscellaneous

A. Governing Law

  1. Jurisdiction:
    This Agreement is governed by the laws of [Jurisdiction], and any legal actions relating to the enforcement or interpretation of this Agreement will be subject to the laws of that jurisdiction. Both parties agree that any disputes not resolved through negotiation or arbitration will be resolved in the courts located within [Jurisdiction].

    • The Client acknowledges that by entering into this Agreement, they consent to the jurisdiction and venue of [Jurisdiction], where any legal actions arising from this Agreement will take place.

B. Entire Agreement

  1. Comprehensive Understanding:
    This Agreement, along with its appendices and any addendums, represents the entire understanding between the Client and [Your Company Name] with respect to chiropractic care. It supersedes all previous agreements, discussions, and representations, whether oral or written, regarding the Client’s treatment or care at the Clinic.

    • The Client acknowledges that they have read and fully understand the terms of this Agreement, and that they have had the opportunity to ask questions and seek clarification about the terms and conditions.

C. Amendments

  1. Modification of Terms:
    Any amendments, modifications, or additions to this Agreement must be made in writing and signed by both parties to be legally binding. No verbal agreements or assurances will be deemed valid unless documented in writing and signed by both the Client and the Clinic.

    • The Clinic reserves the right to modify the terms of this Agreement in the future, and any such modifications will be communicated to the Client in writing, and will become effective only upon mutual consent or upon the Client’s continued engagement with the Clinic after the change is made.

    • Any changes made to the Agreement will reflect the evolving nature of chiropractic care and the Clinic’s practices, ensuring the most up-to-date and client-focused services.

X. Signatures

Client

Name:                              

Date:                               

[Your Company Name]

Name:                              

Date:                               

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