I understand that payment is due at the time of the treatment unless arrangements have been made otherwise. I also understand that I am responsible for the payment if third party payment is not made.

I agree to give 24 hour notice of cancellation for any appointment. If less than 24 hour notice is given, I agree that The Doorway may charge me for the time if unable to fill the appointment with another person. Cases of extreme emergency are considered exceptions.

Prior to the provision of any service you, a complementary and alternative health care client, must sign this written statement attesting that you, the client, have read, reviewed and understand the Complementary and Alternative Health Care Client Bill of Rights.

By providing your email address on the intake form you consent to The Doorway to send you emails.

1. Our Staff Profiles are listed here http://thedoorwayforbetterhealth.com/meet-our-therapists
   
   “THE STATE OF MINNESOTA HAS NOT ADOPTED ANY EDUCATIONAL AND TRAINING STANDARDS FOR UNLICENSED COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS. THIS STATEMENTIS FOR INFORMATIONAL PURPOSES OLNY”
   
   Under Minnesota law, an unlicensed complementary and alternative health care practitioner (CaAHCP) may not provide a medical diagnosis or recommend discontinuance of medically prescribed treatments. If a client desires a diagnosis from a licensed physician, chiropractor, nurse, osteopath, physical therapist, dietician, nutritionist, acupuncture practitioner, athletic trainer, or any other type of health care provider, the client may seek such services at any time.
   
2. Owner, Operator and CNMT is David A Wicklund. If you have any questions, comments or complaints, you are encouraged to file them in person, written or by phone with the owner. Business address: 2206 44th Ave N Mpls, MN 55412. Phone: (612) 619-0881 Email: thedoorwaymassage@yahoo.com
3. If client has complaints, and they feel uncomfortable with contacting the owner, they may be filed with: The Office of Unlicensed Complementary and Alternative Health Care Practice Minnesota Department of Health, PO Box 64975, St.Paul, MN 55164-0975. Phone: (651) 282-5623.
4. Please see price list for full details on prices, discounts and polices. Clients must pay all fees in full at time of services rendered. You have the right to reasonable notice of changes in services or charges, which will be emailed 30 days prior to changes.
5. Your practitioner may use any or all of the following techniques during your session: Swedish, Myofascial, Neuromuscular Therapy, Sports Massage, Integrated, and related stretches , or any of the many other modalities that our talented therapist use (see staff profiles); all with the intent of benefiting your well-being
6. As the client, you have the right to complete and current information concerning the practitioner’s assessment and recommended service to be provided.
7. As the client you may expect courteous treatment and to be free from verbal, pysical or sexual abuse by the CaAHCP.
8. As the client , your records and transactions with the CaAHCP are confidential, unless release of those records is authorized in writing by the client, or otherwise provided by law. The client has the right to be allowed access to the records and written information from records in accordance with section 144.335 of Minnesota Law.
9. You should be aware that other services similar to those provided by the CaAHCP may be available in the community. Mention of these services is not an endorsement of anothe CaAHCP.
10. You have the right to coordinated transfer when there will be a change in the services provided.
11. You may refuse services or treatment unless otherwise provided by the law.
12. You may assert these right without retaliation.