Terms of Service

Classic Rehabilitation, Inc. Physical Therapy Outpatient Clinic
Effective Date: March 12, 2026

Welcome to Classic Rehabilitation, Inc. By scheduling, receiving, or participating in services provided by our clinic, you agree to the following Terms of Service.

1. Services Provided

Classic Rehabilitation, Inc. provides outpatient physical therapy services including evaluation, treatment, rehabilitation, injury prevention, and wellness services provided by licensed physical therapists and healthcare professionals.

Services may include but are not limited to:

• Physical therapy evaluation and treatment
• Manual therapy
• Therapeutic exercise
• Modalities (ultrasound, electrical stimulation, etc.)
• Post-surgical rehabilitation
• Injury prevention programs
• Patient education

Treatment plans are determined by the therapist based on professional judgment and medical necessity.

2. Patient Responsibilities

• Provide accurate and complete medical history.
• Inform the therapist of any changes in health status.
• Follow the prescribed treatment plan and instructions.
• Arrive on time for scheduled appointments.
• Notify the clinic of cancellations within the required timeframe.

Failure to follow treatment recommendations may affect outcomes and progress.

3. Appointment Scheduling and Cancellation Policy

Appointments are scheduled to ensure appropriate care and therapist availability.

• Provide at least 24 hours notice for cancellations or rescheduling.
• Late cancellations or missed appointments may incur a no-show or late cancellation fee of $25.00
• Repeated missed appointments may result in discontinuation of care.
• Late arrivals may result in shortened sessions or rescheduling.

4. Payment and Insurance

Payment is due at the time services are provided unless other arrangements are made.

• Patients are responsible for providing copays, deductibles, and non-covered services.
• Insurance coverage is not guaranteed, and patients remain responsible for unpaid balances.
• The clinic may verify benefits, but this is not a guarantee of payment.
• Outstanding balances must be paid within 30 days of billing.

5. Self-Pay Services

For patients not using insurance, payment is due at the time of service unless payment plans are approved by the clinic. Self-pay rates may vary based on service type.

6. Consent to Treatment

By receiving services, patients consent to physical therapy treatment provided by licensed professionals.

Patients understand:

• Physical therapy involves manual therapy, movement, and exercise.
• Some discomfort may occur during rehabilitation.
• Risks may include soreness, aggravation of symptoms, or injury.
• Patients may withdraw consent at any time.

7. Privacy and Confidentiality

Classic Rehabilitation, Inc. complies with HIPAA (Health Insurance Portability and Accountability Act) regulations regarding the protection of patient health information.

Patient health information will only be used or disclosed as permitted by law or with patient authorization. Patients may request a copy of the clinic’s Notice of Privacy Practices.

8. Medical Emergencies

Classic Rehabilitation, Inc. is an outpatient rehabilitation clinic and not an emergency medical facility. If a patient experiences a medical emergency, they should call 911 or seek emergency medical care immediately.

9. Termination of Services

• Patients repeatedly miss appointments
• Patients fail to follow treatment recommendations
• Patient behavior is disruptive, unsafe, or abusive
• Financial obligations are not met

Patients may also discontinue care at any time.

10. Limitation of Liability

While our providers strive to provide the highest standard of care, outcomes cannot be guaranteed.

Classic Rehabilitation, Inc. shall not be liable for:

• Failure to follow therapist recommendations
• Failure to disclose medical history
• Noncompliance with treatment plans

11. Changes to Terms

Classic Rehabilitation Inc. may update these Terms of Service periodically. Updated terms will be posted at the clinic or on the clinic website. Continued use of services indicates acceptance of updated terms.

12. Contact Information

Classic Rehabilitation, Inc.
504 N. Carrier Pkwy
Grand Prairie, TX 75050
Phone: (817)226-2622
Email: info@classicrehabilitation.com

Acknowledgment

By signing below or receiving services at Classic Rehabilitation, I acknowledge that I have read and agree to these Terms of Service.

Patient Name: ______________________

Signature: _________________________

Date: _____________________________