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Patient Financial Agreements & Your Holistic Practice (+ Template)

Patient financial agreements can help your holistic practice

Your holistic practice exists to deliver quality care to your patients—and somebody has to pay for that quality care. Your patients might not exactly know their role or responsibility in paying for the services rendered—for example, there could be assumptions about insurance coverage that doesn’t apply to your holistic practice—which can lead to friction later down the line.

That’s where a patient financial agreement can help your holistic practice improve the patient-payer-practice relationship and start the conversation about patient responsibility! Keep reading to learn more.

What Is Involved in a Patient Financial Agreement?

A patient financial agreement can contain a multitude of components depending on how extensive your practice’s policies are and what best suits your patients. For example, if any of your clients pay by check, then you’ll want to outline if there are any special fees or steps in the event a check has trouble processing.

For the most part, your holistic practice will want to include the following core components when drafting your patient financial agreement:

Be Clear About Insurance/Medicare Coverage

The chances are that your holistic practice doesn’t provide healthcare that is covered by insurance—and while there are important legislative initiatives that would expand Medicare’s coverage of holistic treatments, such rulings are not in place as of yet.

Make sure you clearly explain if your practice doesn’t take any insurance coverage or provide details if you do happen to be contracted with a third-party payer. While your patients should ideally be informed of what their insurance coverage includes, many of them might have a blind spot when it comes to coverage for holistic treatments.

Clarify the Patient Is Responsible as the Payer

Since your practice likely doesn’t take insurance, make sure it’s clear on the financial agreement that your patient is responsible for the financial aspect of services rendered. In the case that you do accept insurance, remind the patient that they’re responsible for paying their deductible before coverage starts. The patient is also responsible for any unpaid balances.

Clarifying the patient’s financial role in your holistic practice can contribute to patient engagement and help them realize what responsibility they have in their relationship with your holistic practice.

Outline Payment Options

Does your practice take cash only? Credit cards? Venmo? Briefly state what options your patients have for paying their balance, whether that’s at the time of checking in, checking out, or via an online payment portal.

Encourage Questions

Seeing the words FINANCIAL AGREEMENT might be intimidating to patients and seem like a formal legal document; while you don’t want to minimize the importance of the patient understanding their financial responsibility, you also don’t want to keep the process opaque.

Encourage questions both when you hand the agreement to your patient and consider adding a point of asking questions in the preface of the agreement. Keeping the lines of patient communication open can help your practice fortify the patient-practice relationship and boost patient engagement, which is always a good thing.

Why Is a Patient Financial Agreement Helpful To Your Holistic Practice?

Keep your patients apprised of their financial roles in your practice

While your patients no doubt understand that they need to pay for the care your holistic practice provides them, there might be some confusion about how that happens. Especially for new patients, a patient financial agreement can simply function to clarify or reiterate your practice’s policies, any potential fees for no-show appointments or bounced checks, and if your practice has any relationships with insurance providers or Medicare.

The patient financial agreement is also a great prompt for your patients to ask any questions about paying for your services. Starting this conversation can further build rapport and trust with your patients, which is crucial for patient engagement and patient satisfaction!

Patient Financial Agreement Template

Your holistic practice’s patient financial agreement can take whatever form you wish; it might be shorter or longer depending on how in-depth you want to be on your agreement. You might include your practice’s mission statement or other branding or contact information in the header, which can also take up space.

The following template is simply an example of what you could include; tailor it to best suit your holistic practice’s needs!

Thank you for choosing [Name of holistic practice] for your holistic wellness needs. We’re committed to providing you with quality care. We ask all clients to review and sign this policy, asking questions as necessary. A copy will be provided to each client upon request. 

  • Patient payment: The patient is responsible for payment at the time of service unless XYZ [if applicable].
  • Payment methods: Explain if you take credit card payments, cash, checks, etc. Include any relevant fees that might incur if payment doesn’t go through, such as a service fee for bounced checks, etc.
  • Proof of payment and photo ID required: Some practices might want to keep a photocopy of the patient’s ID on file
  • No-show fees: Outline your practice’s no-show policy here
  • Insurance/Medicare Programs: Some holistic practices and their specialties are accepted by third-party payers; outline those guidelines here or explain that you don’t accept any insurance or CMS patients. In this latter case, reiterate that the patient is responsible for payment.

I have read the above financial policies and agree to follow [Name of holistic practice’s] policies and I acknowledge my financial responsibility for services rendered.

Patient Name

Patient Signature


Spend More Time with Patients by Partnering with Holistic Billing Services!

The overall healthcare revenue cycle can be incredibly complex and lead to a lot of stress. If your holistic practice wants to spend less time dealing with medical coding, billing, and trying to keep up with new regulations, then partner with Holistic Billing Services and spend more time on what matters most: your patients!

Our experts have decades of experience and expertise in your specialty. We’re eager to help you succeed!

Contact us today!

May 13, 2022
 - by Antonio Arias, MBA, CHBME
Patient financial agreements can help your holistic practice
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