Effective Date: 8/28/2025
Clinic Name: Authorized Pulmonary Testing Clinic
By accessing or using the services provided by Authorized Pulmonary Testing Clinic (“we,” “our,” or “us”), including clinical visits, diagnostic testing, consultations, and use of our website, you agree to the following Terms and Conditions.
1. Medical Disclaimer
Our clinic provides pulmonary testing and related diagnostic services.
Information provided by our staff, website, or written materials is not a substitute for medical advice from your physician or other qualified healthcare provider.
You should always consult your physician before making decisions about your healthcare.
2. Eligibility for Services
Services are available to individuals referred by a physician or self-referred, subject to medical appropriateness.
You must provide accurate, complete, and updated personal and medical information.
We reserve the right to refuse or discontinue services if false or misleading information is provided, or if your behavior is disruptive or unsafe.
3. Appointments & Cancellations
Please arrive at least 15 minutes prior to your appointment.
If you need to cancel or reschedule, we require [Insert Timeframe, e.g., 24 hours’] notice.
Missed appointments or late cancellations may be subject to a fee.
4. Payment & Insurance
You are responsible for all charges for services rendered, whether or not covered by insurance.
We may bill your insurance company as a courtesy, but payment of deductibles, copayments, and non-covered services is your responsibility.
Payment is due at the time of service unless otherwise arranged.
5. Use of Website & Online Content (if applicable)
Content on our website is provided for informational purposes only.
Unauthorized use, reproduction, or distribution of website content is prohibited.
We do not guarantee uninterrupted or error-free access to our website.
6. Limitation of Liability
While we maintain high standards of care, we are not liable for:
Outcomes based on incomplete or inaccurate information you provide.
Misuse of test results outside of proper medical guidance.
Any indirect, incidental, or consequential damages related to use of our services or website.
7. Patient Responsibilities
By receiving services, you agree to:
Provide complete and accurate health information.
Follow pre-test instructions (e.g., avoiding smoking, fasting, or withholding medications if required).
Treat staff and other patients with respect.
Take responsibility for your medical follow-up with your referring physician.
8. Privacy & Confidentiality
Your health information is protected under HIPAA and our [Privacy Policy].
Please review our Notice of Privacy Practices for details on how we handle your information.
9. Modifications to Terms
We reserve the right to update these Terms and Conditions at any time. Updates will be effective immediately upon posting in our clinic or on our website.
10. Governing Law
These Terms and Conditions are governed by the laws of the state of [Insert State], without regard to conflicts of law principles.
11. Contact Information
For questions about these Terms and Conditions, please contact:
Authorized Pulmonary Testing Clinic
[Clinic Address]
[Phone Number]
[Email Address]
⚖️ Note: It’s good practice to have patients acknowledge the Terms & Conditions + Privacy Policy (often combined on a single acknowledgment form for intake).
👉 Do you want me to create a combined one-page patient acknowledgment form where they sign off on receiving the HIPAA NPP, Privacy Policy, and agreeing to the Terms & Conditions? That way you’re fully covered.