By my signature below, I understand, acknowledge, and agree that I am fully responsible for payment of services provided to me by Virginia Infusion Therapies and that payment must be made in full by cash, or credit card at or before the time of service.
I understand that treatment and services provided by Virginia Infusion Therapies may not be covered by my insurance. Virginia Infusion Therapies does not contract with any insurance plan. Virginia Infusion Therapies will provide information to me to assist me in my claim for reimbursement to my insurance carrier, however they will not submit claims to insurers on my behalf. I further acknowledge and agree that if I choose to submit any bill or itemized receipt to an insurance carrier for reimbursement for these services, that Virginia Infusion Therapies is exempt from any dispute regarding reimbursement.
To fairly and effectively serve patients who wish to receive treatment, the following cancellation policy has been implemented. By your signature below you acknowledge and agree to the following cancellation policy:
Short (Approx. 40 min) infusions must be cancelled within 72 hours after you accept the proposed schedule, in order to receive a full refund. Short (Approx. 40 min) infusions cancelled after 72 hours will incur a $325 charge, payable by funds prepaid to your account or charged to your credit card on file. No refund will be made for cancelations with less than 48 hours of your scheduled appointment.
Long (Approx. 4 hr) infusions must be cancelled within 72 hours after you accept the proposed schedule, in order to receive a full refund. Long (Approx. 4 hr) infusions cancelled after this time will incur a $500 charge, payable by funds prepaid to your account or charged to your credit card on file. No refund will be made for cancelations with less than 72 hours of your scheduled appointment.
Virginia Infusion Therapies
The First Ketamine Clinic in Northern Virginia
Virginia Infusion Therapies is one of the the first Ketamine Clinics in Northern Virginia, and the first clinic in Loudoun County to provide Ketamine infusion therapy for the treatment of Major Depression and Pain Conditions. The clinic was established by four physicians in Loudoun who, through their professional experiences in medicine and their personal family experiences with depression, recognized that there are major problems in the recognition and treatment of depression. They recognized that Major Depression, Post-Traumatic Stress Syndrome, and some pain conditions are often medical emergencies that requires treatments that are more effective… and more effective IMMEDIATELY.
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