Solari Wellness

Financial Responsibility Agreement

By signing this agreement, I acknowledge and agree to the following financial policies.

Private-Pay Practice

I understand that Solari Wellness is a private-pay wellness practice.

I understand that Solari Wellness does not bill insurance companies, Medicare, Medicaid, or other third-party payers.

Financial Responsibility

I understand that I am personally responsible for all fees associated with services, consultations, laboratory testing, wellness programs, and products that I choose to purchase from Solari Wellness.

I understand that payment is required prior to services being rendered.

I understand that Solari Wellness reserves the right to withhold scheduling, consultations, laboratory interpretation, wellness plans, protocol development, written recommendations, educational reports, follow-up services, and all other deliverables until payment has been received in full.

Laboratory Testing

I understand that laboratory testing is not included unless specifically stated.

I understand that recommended laboratory testing may result in additional out-of-pocket expenses.

I understand that laboratory costs vary depending on the testing selected.

Supplements & Wellness Products

I understand that supplement recommendations are optional.

I understand that supplements, wellness products, devices, memberships, and other recommendations may involve additional expenses and are not included in consultation fees unless specifically stated.

Insurance Reimbursement

I understand that Solari Wellness makes no representations regarding insurance reimbursement.

I understand that any reimbursement from an insurance company, HSA, FSA, or other benefit program is solely my responsibility to verify.

Pricing

I understand that current pricing is available at:

https://www.solariwell.com/services

I understand that pricing may change at any time without prior notice.

No Refunds for Services Already Rendered

I understand that fees for completed consultations, educational services, laboratory reviews, protocol development, and related services are generally non-refundable once services have been performed.

Acknowledgment

I have reviewed and understand the financial policies outlined above.

I understand that Solari Wellness is a private-pay practice and does not bill insurance.

I understand that payment is required before services are rendered.

I understand that laboratory testing and supplement recommendations may involve additional out-of-pocket expenses.

I accept financial responsibility for services and purchases I voluntarily choose to obtain.

First name

Last name

Date

Month

Day

Year

Digital Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.