Private Client Services Agreement

Payment, Cancellation, & Terms of Service
C.L.E.A.N. Tobacco Recovery System

1. Insurance & Reimbursement

C.L.E.A.N. Tobacco Recovery System does not participate in any insurance networks. Hypnotherapy, behavioral coaching, and recovery services are generally not covered by standard health insurance plans.

Upon payment, clients may request a receipt for personal records and potential reimbursement submission. Reimbursement is not guaranteed and is solely the responsibility of the client.

Possible reimbursement options may include:

1. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs)
   Some plans may allow the use of HSA or FSA funds for complementary or behavioral services when deemed medically necessary.

2. Out-of-Network Benefits
   Certain insurance plans may permit reimbursement for services obtained outside their network.

3. Medical Necessity Documentation
   Coverage may require written documentation from a licensed healthcare provider.

4. Employee Assistance Programs (EAPs)
   Some employers offer limited wellness or counseling benefits.

5. Specialized Health Plans
   Certain alternative or supplemental plans may provide limited coverage.

Clients are responsible for contacting their insurance provider directly to verify eligibility, documentation requirements, and reimbursement policies.

C.L.E.A.N. makes no representations regarding insurance coverage.

2. Payment Policy

Advance Payment Requirement

Full payment is required in advance to secure an appointment. Sessions are confirmed only after payment is received.

Appointments are not held without completed payment.

3. No Refund Policy

Due to the reserved professional time and individualized preparation involved in private services, all payments are final.

No refunds are issued under any circumstances, including:

• Change of mind

• Scheduling conflicts

• Failure to attend

• Dissatisfaction after services are rendered

By booking, you acknowledge and accept this policy.

4. Time Commitment & Attendance

When you schedule a session, dedicated professional time is reserved exclusively for you.

Late Arrival

Sessions conclude at the scheduled time regardless of arrival time. Late arrivals result in reduced session duration without refund.

Failure to attend a scheduled session without notice is considered a no-show. No refunds or credits are issued.

5. Rescheduling Policy

Clients may reschedule appointments with a minimum of 72 hours’ notice.

Requests made with less than 72 hours’ notice are treated as late cancellations and are not eligible for rescheduling or credit.

6. Eligibility & Client Qualifications

Age Requirement: Clients must be at least eighteen (18) years of age. Minors must provide written consent from a parent or legal guardian prior to receiving services.

Mental Health Considerations: C.L.E.A.N. services are not appropriate for individuals experiencing untreated psychosis, schizophrenia, or severe psychiatric instability.

If such conditions are present, written authorization from a licensed treating physician is required prior to participation.

The Provider reserves the right to decline services if participation may pose risk to the client’s well-being.

7. Scope of Services

C.L.E.A.N. private services are educational and behavioral coaching interventions.

They do not constitute:

• Medical treatment

• Psychiatric care

• Psychological therapy

• Emergency services

Clients are encouraged to seek licensed medical care for medical or psychiatric conditions.

8. Client Responsibility

By engaging in services, clients agree to:

• Provide accurate information

• Participate honestly

• Follow program guidance

• Maintain personal accountability for outcomes

Results depend on individual commitment and participation. No specific outcomes are guaranteed.

9. Termination of Services

C.L.E.A.N. reserves the right to terminate services at its discretion for:

• Boundary violations

• Harassment

• Dishonest conduct

• Disruptive behavior

• Noncompliance with policies

Termination does not entitle the client to refunds.

10. Agreement Acknowledgment

By booking and participating in private services, you acknowledge that you have read, understood, and agreed to this Private Client Services Agreement.

C.L.E.A.N. Tobacco Recovery System

Email: info@cleantobaccorecovery.com