TERMS AND CONDITIONS OF SERVICE & COMMUNICATION CONSENT

Dakota Hegi Chiropractor
Derby, Kansas
Effective Date: August 11, 2026

By receiving services from Dakota Hegi Chiropractor, using our patient portal or online scheduling services, or agreeing to these Terms and Conditions, you acknowledge and agree to the following terms.

1. CHIROPRACTIC SERVICES

Dakota Hegi Chiropractor provides chiropractic and related healthcare services within the scope of practice permitted by Kansas law.

Chiropractic care does not guarantee any particular result or outcome. Treatment recommendations may vary based upon examination findings, medical history, response to treatment, and other relevant factors.

These Terms and Conditions do not replace any informed consent documents that may be required for specific treatments or procedures.

2. PATIENT RESPONSIBILITIES

You agree to provide accurate and complete information regarding your health history, medications, injuries, symptoms, insurance coverage, and other information reasonably necessary for your care.

You are responsible for notifying the office of material changes to your health, contact information, insurance information, or other information relevant to your treatment or account.

3. APPOINTMENTS AND SCHEDULING

Appointments may be scheduled in person, by telephone, electronically, through the patient portal, or through other scheduling methods offered by the practice.

Patients are responsible for keeping scheduled appointments or providing reasonable notice when an appointment must be changed or canceled.

The practice reserves the right to establish or modify scheduling, cancellation, late-arrival, and no-show policies.

4. PAYMENT AND FINANCIAL RESPONSIBILITY

You are responsible for charges associated with services provided to you except to the extent those charges are paid by an insurance company or other responsible third party.

Insurance coverage is not a guarantee of payment. Any estimate of insurance benefits provided by our office is an estimate only.

You remain responsible for applicable deductibles, copayments, coinsurance, non-covered services, and other patient-responsibility amounts permitted by your insurance agreement and applicable law.

You agree to provide accurate and current insurance information when requesting that claims be submitted on your behalf.

5. INSURANCE CLAIMS

As a convenience to patients, Dakota Hegi Chiropractor may submit claims to participating insurance companies.

You authorize the release of information reasonably necessary to process healthcare claims, determine benefits, obtain payment, and perform other activities permitted by applicable law.

You understand that the insurance company ultimately determines coverage and benefits according to your insurance plan.

6. ELECTRONIC COMMUNICATIONS

You authorize Dakota Hegi Chiropractor to communicate with you electronically regarding your care and your relationship with the practice, subject to applicable law and your communication preferences.

Electronic communications may include:

• Appointment confirmations and reminders;

• Appointment scheduling and rescheduling;

• Patient portal notifications;

• Office closures or schedule changes;

• Billing and account notifications;

• Requests to contact the office;

• Treatment-related or follow-up communications;

• Forms or paperwork reminders; and

• Other administrative or healthcare-related communications.

Electronic communications may be sent using information you provide to the practice, including your mobile telephone number and email address.

7. SMS/Text Messaging Terms & Conditions

By providing your mobile phone number and opting in to receive SMS/text messages from our practice, you consent to receive text messages related to your relationship with our practice. These messages may include appointment confirmations, appointment reminders, scheduling and rescheduling communications, cancellation notices, office updates, and other service-related communications.

Consent: Your consent to receive SMS/text messages is voluntary and is not a condition of purchasing goods or services.

Message Frequency: Message frequency varies depending on your appointments, requests, and interactions with our practice.

Message and Data Rates: Message and data rates may apply. Your mobile carrier’s standard messaging and data charges may apply.

Opt-Out: You may opt out of receiving SMS/text messages at any time by replying STOP. After you send STOP, you may receive a confirmation message indicating that you have been unsubscribed. You will not receive additional SMS messages unless you opt in again.

Help: For assistance with SMS/text messaging, reply HELP or contact our office directly.

Carrier Disclaimer: Mobile carriers are not liable for delayed or undelivered messages.

Privacy: We respect your privacy. Mobile phone numbers, SMS opt-in information, and SMS consent will not be sold, rented, or shared with third parties or affiliates for marketing or promotional purposes. Please review our Privacy Policy for additional information regarding how we collect, use, and protect your information.

By opting in to SMS/text messaging, you acknowledge that you have read and agree to these SMS/Text Messaging Terms & Conditions.

8. TEXT MESSAGE PRIVACY AND SECURITY

Standard SMS/text messaging may not always be a secure method of transmitting sensitive health information.

Although the practice takes reasonable steps to protect patient information, ordinary text messages may be accessible to anyone with access to your telephone, mobile account, notification screen, backups, or other connected devices.

You should avoid sending highly sensitive medical information through ordinary text messaging unless specifically requested or an appropriate secure communication method is being used.

Where appropriate, the practice may direct you to communicate through the patient portal or another secure method.

9. EMAIL COMMUNICATIONS

If you provide an email address, the practice may use it for authorized administrative and healthcare-related communications.

Email may not always be encrypted or completely secure. You may request reasonable alternative communication methods by contacting the office.

10. PATIENT PORTAL

The practice may provide access to an electronic patient portal for scheduling, forms, communications, records, billing, or other services.

You are responsible for maintaining the confidentiality of your login information and for notifying the practice or portal provider if you believe your account has been accessed without authorization.

You should not allow another individual to access your patient portal unless you intend for that person to have access to the information available through your account.

11. COMMUNICATION IS NOT FOR EMERGENCIES

Text messages, email, patient portal messages, social media, and other electronic communications should not be used for medical emergencies or other urgent situations requiring immediate attention.

Electronic communications may not be monitored continuously, and the practice does not guarantee an immediate response.

If you believe you are experiencing a medical emergency, call 911 or seek appropriate emergency medical care.

12. COMMUNICATION PREFERENCES

You may request reasonable changes to how the practice communicates with you.

Opting out of one communication method does not necessarily prevent the practice from contacting you through another lawful method when necessary for treatment, payment, healthcare operations, legal obligations, or other permitted purposes.

13. PRIVACY

Patient health information will be handled in accordance with applicable federal and Kansas privacy laws and the practice’s Notice of Privacy Practices.

Nothing in these Terms and Conditions authorizes the practice to use or disclose protected health information in a manner prohibited by applicable law.

14. THIRD-PARTY SERVICES

The practice may use third-party service providers for functions such as electronic health records, patient portals, appointment scheduling, billing, payment processing, email, and text messaging.

Use of these services may also be subject to the applicable provider’s terms and privacy practices.

The practice will use third-party service providers in accordance with applicable privacy and healthcare requirements.

15. CHANGES TO THESE TERMS

Dakota Hegi Chiropractor may modify these Terms and Conditions from time to time to reflect changes in practice operations, technology, services, or applicable law.

The current version will be made available to patients as appropriate.

16. GOVERNING LAW

These Terms and Conditions are governed by applicable federal law and the laws of the State of Kansas.

If any provision is determined to be invalid or unenforceable, the remaining provisions will remain in effect to the extent permitted by law.

PATIENT ACKNOWLEDGMENT AND COMMUNICATION CONSENT

By signing or electronically accepting below, I acknowledge that I have reviewed and agree to these Terms and Conditions.

I understand that electronic communications carry certain privacy risks and that electronic communications should not be used for emergencies.

OPTIONAL SMS/TEXT MESSAGE CONSENT

☐ YES, I consent to receive SMS/text messages from Dakota Hegi Chiropractor at the mobile number I provide for appointment reminders, scheduling, office notifications, billing/account communications, and other healthcare-related communications.

I understand that message frequency may vary and message and data rates may apply. I understand that consent to receive text messages is not a condition of receiving treatment or purchasing services. I may withdraw my consent or opt out of text messages as described above.