BUSINESS NEW PATIENT REGISTRATION FORM

Locations we service: Although we service most of San Diego County and parts of southern Orange County, when and where we schedule appointments is completely up to the discretion of Dr. Bruno.

Appointment verification: We verify every appointment by text message unless an alternative contact method is requested. If we do not receive a response prior to your appointment, we will consider the appointment canceled and a cancellation fee of $50.00 will be charged.

Be prepared and on time: We will be prepared and on time for your appointment and ask the same of you. You have a dedicated time slot based on the session type that you choose, either 30 or 60 minutes. Your appointment starts at your scheduled appointment time and ends either 30 or 60 minutes from that time regardless of when treatment commences.

Canceled or missed appointments: Please give 24 hr or "day before" notice for an appointment that needs to be canceled or rescheduled. If appropriate notice is not given, you will be charged a $50.00 cancellation fee.

Right of refusal: We reserve the right to refuse service to anyone at any time for any reason.

Fees: Our fees are located on the "Fees" page of our website. By clicking "I agree" at the end of this form, you are agreeing to the fees as listed.

Payment methods: All payments are due prior to, or at the time of your appointment. Payments can be made by cash, local check or credit card. Checks not honored by your bank will be subject to an additional $30 fee.

Health insurance: We do not accept health insurance and do not assist with any attempt at reimbursement for our services.

Refunds: Completed appointments are not refundable.

Receipts: Receipts are available by email when requested.

Additional fees: Additional fees may apply for appointments outside of our normal service area or normal hours. However, we are 100% transparent with our fees and you will never be charged an additional fee without discussing and agreeing to these fees with Dr. Bruno.

Our privacy policies can be found on our website. You can also request a copy of privacy policies which will be send by email only.

Congratulations on choosing one of the safest and most natural health care programs available!

In accordance with California state law, this notice is to inform you, as a patient, of the material risks of undergoing chiropractic care and/or physiotherapeutic rehabilitation. Material risk means that there are known inherent risks from a particular treatment and certain complications, though improbable, could occur. These rare complications include, but are not limited to, minor muscle strains, intervertebral disc compromise, fractures, dislocations, skin irritation, and cardiovascular accidents. I understand my doctor will not be able to anticipate all potential complications, but elect to rely on his/her clinical expertise and judgment to determine courses of clinical action, based upon known facts, which are considered in my best interest.

I have read and understand the preceding statements and hereby consent to voluntarily participate in chiropractic care and/or physiotherapeutic rehabilitation procedures as deemed appropriate by my doctor. If at any time I decide that I am unwilling to engage in these procedures, I reserve the right to inform my doctor of such and not participate in these forms of evaluation and treatment. I understand that results are not guaranteed and that I have the opportunity to discuss the purposes and risks associated with all recommended evaluation and treatment procedures at any time.