The Lotus Flower
Conditions of Service
This Conditions of Service agreement sets forth the terms and conditions under which The Lotus Flower will provide professional services to you. Please read it carefully before signing it.
1. Treatment and Care. The Lotus Flower will use its best efforts to provide safe, effective, and compassionate care to you. You understand and agree that there are risks associated with all medical care, including the care that will be provided to you by The Lotus Flower. You also understand and agree that individuals not employed by The Lotus Flower, including independent behavior analysts, may be involved in your care. The Lotus Flower does not and cannot guarantee that all care and treatment you receive will be effective or produce the results that you desire. By agreeing to receive assessment and care via telemedicine (e.g., by phone, videoconference, or similar, remote means), you are agreeing to accept the additional risks associated with telemedicine services. These risks include the possibility that important information may not be communicated fully or effectively, that computer or Internet problems will cause outages or delays, and that your medical information will be intercepted during a session due to hacking or other security incidents.
2. Payment for Care. You are responsible to pay for all services and supplies that you receive from The Lotus Flower. The Lotus Flower does accept payment from some insurance companies, government payer programs, and private payer companies. However, you will be billed for, and are expected to pay, any amounts that are left over after those companies and programs have made payment. If you have questions about The Lotus Flower’s payment policies, or if you have trouble paying your bills in a timely manner, please consult with your care provider.
3. Cancellations and Postponements. You are expected to arrive ready and on time for all scheduled appointments with The Lotus Flower. If you are unable to make a scheduled appointment due to illness or other issues, then you are expected to cancel or reschedule the appointment as soon as possible. If you cancel or attempt to reschedule an appointment within 24 hours or less of the scheduled appointment time, then The Lotus Flower reserves the right to charge you for 1 hours’ worth of that appointment time. Please note that this late cancellation or rescheduling fee must be paid out of pocket; it is not chargeable to insurance. If you cancel or attempt to reschedule appointments repeatedly, then The Lotus Flower may terminate or limit its provider-client relationship with you.
4. Communication and Behavior. The Lotus Flower will communicate and interact with you in a respectful, polite, and caring manner. Our goal is to make you feel comfortable and valued at all times. You are expected to treat The Lotus Flower, its providers, and its staff in a similar manner. The Lotus Flower reserves the right to terminate or limit its treatment relationship with you if you, your family member, or anyone else involved in your care treats an employee or agent of The Lotus Flower in an intimidating, threatening, rude, dismissive, or otherwise inappropriate manner. In determining whether a termination or limitation of treatment is warranted, The Lotus Flower will take into account all relevant circumstances, including any communication- or behavior-related conditions for which you have sought treatment.
5. Medical Records. The Lotus Flower will create medical records detailing the assessment, care, and treatment that it provides to you. These records will be kept in a confidential and secure manner. You may obtain copies of your medical records by completing, signing, and providing to The Lotus Flower an appropriate release of information authorization form. By using The Lotus Flower’s patient portal, you are agreeing to receive your medical information electronically via the portal, despite the risk that the information may be subject to hacking or otherwise lost in transmission.
6. Social Media. Because of the importance of maintaining appropriate professional boundaries, your care provider at The Lotus Flower will not “friend” you or otherwise interact with you via social media. When using social media and other public-facing communication tools, you are expected to be respectful of the privacy of the providers, staff, and other clients of The Lotus Flower. It is important that you do not identify anyone other than yourself (or the person on whose behalf you are signing this form) as a client of The Lotus Flower or discuss any information about another client’s medical condition, treatment, or prognosis.
7. Filming and Recording. Unless you have received express permission from your provider in advance, you are not permitted to make video or audio recordings, or to take pictures, during any assessment or treatment sessions. If The Lotus Flower learns that you are secretly recording conversations or interactions during such sessions, then it may terminate or limit its provider-client relationship with you.
8. Questions and Concerns. The Lotus Flower believes that you will achieve your best outcomes if you help establish an open and honest relationship with your care team. If you have any questions or concerns about the care that you receive from The Lotus Flower, please do not hesitate to contact us by phone or e-mail. Our contact information is as follows:
The Lotus Flower
E-mail: anne@thelotusflowerhealer.com
Tel. No: (458) 206-0653
Alternatively, you may file your complaint directly with the Oregon Health Authority by mailing a letter to the Health License Office, 1430 Tandem Avenue NE, Suite 180, Salem, Oregon 97301-2192 or e mailing hlo.regulatory@odhsoha.oregon.gov.
9. Miscellaneous. The Lotus Flower is an Oregon-based business, and its services are rendered in accordance with applicable federal and state laws, regulations, and standards of care. These Conditions of Service shall be interpreted and enforced in accordance with the laws of the State of Oregon.
THE LOTUS FLOWER 