Payment & Cancellation
Policy Consent

Purpose of This Consent

This document outlines the financial, cancellation, no-show, refund, and payment-related policies of Navara Health, PLLC. By signing, I confirm I have read and agree to these terms.

Self-Pay Practice — Insurance Disclosure

Navara Health is a self-pay practice. I understand and agree that:

• Navara Health does not bill insurance directly
• Navara Health is not contracted with Medicare, Medicaid, TRICARE, or any commercial insurance plan
• I am fully financially responsible for all services received
• Upon request, Navara Health can provide a superbill for me to submit to my insurance plan for possible reimbursement, but reimbursement is not guaranteed
• Most services at Navara Health (hormone optimization, peptides, GLP-1, aesthetics, IV therapy) are not typically covered by insurance
• HSA / FSA funds may be used for eligible services; I am responsible for verifying eligibility with my plan administrator

Accepted Payment Methods

• Credit and debit cards (Visa, MasterCard, American Express, Discover)
• HSA / FSA cards (for eligible services)
• ACH bank transfer
• Cash (in-clinic visits only)
• Other payment methods at Navara Health's discretion

Payment is required at the time of service unless a payment plan or membership arrangement has been established.

Card on File

Navara Health requires a valid credit or debit card to be kept on file for all patients. This card may be charged for:

• Services rendered at the time of visit
• Membership fees (DPC, HRT, recurring programs)
• Late cancellation or no-show fees
• Outstanding balances on the account
• Prescription or product fees

I will notify Navara Health if my card is lost, stolen, expired, or replaced. Payment information is stored securely through a HIPAA-compliant payment processor under a Business Associate Agreement.

Cancellation & No-Show Policy

Notification of cancellation must be made by:

• Patient portal message
• Email to contact@navarahealthtx.com
• Telephone or voicemail to 469-653-3124
• SMS to the number provided

Cancellation and no-show fees will be charged to the card on file. Repeated late cancellations or no-shows may result in termination of the patient-provider relationship.

Deposits for High-Value Procedures

For Vampire procedures, O-Shot®, Vampire Breast Lift®, NAD+ infusions, peptide therapy initiation, and other higher-value services, Navara Health may require a non-refundable deposit at the time of scheduling. Deposits are applied to the cost of the service.

• Deposits are forfeited for no-shows or cancellations made with less than 48 hours' notice for procedure visits
• Deposits may be transferred to a rescheduled appointment if cancellation notice is provided with 48+ hours' notice

Refund Policy

The following refund policies apply:

• Services already rendered: non-refundable
• Medications dispensed or shipped from pharmacy: non-refundable
• Compounded medications: non-refundable once prescription has been submitted to the pharmacy
• Membership fees: non-refundable for completed months; see membership agreement for cancellation terms
• Pre-paid service packages: non-refundable; unused portions may be applied to future services within 12 months of purchase, subject to clinical appropriateness
• Products and supplements (Fullscript): refund subject to Fullscript / vendor policy, not Navara Health policy
• Deposits for procedures: non-refundable for no-shows or late cancellations
• Treatment of complications: may incur additional cost; not covered by original service fee

Membership Programs

Navara Health offers membership programs including:

• Direct Primary Care (DPC) Membership — covered by separate DPC Membership Agreement
• HRT Membership — covered by separate HRT Membership Consent
• Other recurring programs as offered

Each membership has its own enrollment, billing, cancellation, and termination terms outlined in its respective consent or agreement.

Late Payment & Collections

I understand that:

• Outstanding balances are due within 30 days of service unless a payment plan has been arranged
• Balances overdue more than 30 days may incur a $25 late fee per month
• Balances overdue more than 90 days may be referred to collections; I will be responsible for collection fees and any related costs
• Persistent non-payment may result in termination of the patient-provider relationship and refusal of future services

Returned Payments

Returned checks, declined credit card transactions, or chargebacks will incur a $35 returned payment fee. I agree to provide replacement payment promptly. Repeated returned payments may result in card-on-file requirement and pre-payment for all future services.

Chargebacks & Disputes

If I have a billing concern, I agree to first contact Navara Health directly at contact@navarahealthtx.com before initiating a credit card chargeback. Initiating a chargeback without first attempting good-faith resolution may result in:

• Termination of the patient-provider relationship
• Collection action for the disputed amount plus chargeback fees
• Possible legal action to recover fees and costs

Pricing Subject to Change

Service pricing, membership fees, and product pricing are subject to change. Current pricing is available at Navara Health, on the website, or by request. Changes do not affect prepaid services. For ongoing memberships, 30 days' notice will be provided for any pricing changes.

Communication & HIPAA Authorization

I authorize Navara Health to communicate with me about billing, payment reminders, declined payments, late notices, and outstanding balances through:

• Patient portal
• Email
• SMS
• Telephone

I may revoke any specific channel in writing.

Dispute Resolution & Governing Law

Any billing dispute or financial controversy not resolved by good-faith negotiation within thirty (30) days shall be submitted to binding arbitration in Dallas County, Texas. The parties waive the right to a jury trial. This Consent is governed by Texas law.