Aqua Finch LLC (Weightox being its product)

701 Tillery Street Unit 12-2122, Austin,
Texas 78702, United States


Thank you for choosing our services for your needs. Please read the agreement below. It lays out billing, scheduling and cancellation procedures. If you have any questions please ask for clarification.

Payment of all fees is expected at the time of service or via credit card on file.

It is the client’s responsibility to check insurance benefits and coverage. You will be responsible for any non-covered services, deductibles, co-payments or co-insurances, as determined by your insurance carrier. Accounts unpaid by the insurance carrier greater than 90 days will be billed to the client.
I hereby authorize payment of medical benefits directly to Aqua Finch LLC for all services rendered where applicable.

Out-of-pocket payments can be made via credit/debit card, cash or check and are due on the date of your appointment. Credit/debit card payments can be made directly with us.

I hereby authorize Aqua Finch LLC to release to government agencies, insurance carriers and all others who are financially liable for my care, all information to substantiate payments for my care and to permit representatives thereof to examine and make copies of all records related to such care and treatment.

I will be responsible to pay a $45 late cancel fee for any missed or cancelled initial visits, not made at least 24 hours in advance prior to the scheduled appointment time.

If I default on my account, I understand I will be subject to finance and/or legal fees in addition to the total account balance.