Our Policies

Patient Consent for the Collection, Use and Disclosure of Personal Information

A patient privacy policy is in place to outline what we are doing to ensure that:

• Only necessary information is collected about you
• We only share your information with your consent
• Use, storage, retention and destruction of your personal information complies with the standards of practice set by the College of Chiropodists of Ontario

The clinic will only collect, use and disclose personal information for the following purposes:

• To address your health concerns, provide health care and advise you of treatment options
• To establish and maintain contact with you to ensure your foot care needs are adequately met on an ongoing basis
• To remind you of upcoming appointments
• To communicate with other treating healthcare providers including your family physician (includes consent to have imaging results released to our clinic)
• To allow for efficient follow up for treatment and billing
• To complete claims for insurance purposes
• To invoice for goods and services and process payments
• To collect unpaid accounts
• To provide anonymous data for the purpose of teaching, demonstration and research
• To allow this clinic to comply with all regulatory requirements and with the law of Ontario and Canada

Consent to Treatment & Fees

• I understand that Chiropody services are not covered by OHIP.
• I understand that I am to be seen by a Registered Chiropodist and their staff at Step Right Foot Clinic and that scheduling is subject to availability.
• I hereby consent to assessment and treatment for my current and future condition(s). I acknowledge that no assurance or guarantee has been provided to me as to the results of the treatment and that with any treatment there can be risks and those risks have been explained to me and I assume those risks.
• I acknowledge and understand that the practitioner must be fully aware of my existing medical conditions. The information I have provided in my medical history form is true and complete to the best of my knowledge. It is my responsibility to keep the clinic updated on my medical history. I understand that treatment may be performed for therapeutic, preventative, palliative, diagnostic, cosmetic or other health related purposes. I understand that all aspects of treatment will be fully explained to me by the attending Chiropodist and though limited, there may be a risk of local infection, minor bleeding, or pain/discomfort.
• I understand that I am free to withdraw my consent and to discontinue treatment at any time.
• I understand that photographs of my feet, legs and full body (postural assessment) may be taken for my medical records. These will never be shared outside the clinic unless my explicit consent is given or required by law.
• I understand that my visit may be audio-recorded to create a transcript and draft medical documentation notes and that my clinician reviews and finalizes all notes. Audio files will be deleted after 7 days. Processing occurs on servers in North America. All procedures are PHIPA compliant as required under Ontario provincial law.
• I understand that the Clinic may communicate with me electronically via email and/or SMS messages for purposes including, but not limited to, sending medical information such as reports, estimates, prescriptions, appointment confirmations, and other documents that may contain my personal health information.
• I have fully read and understand the above noted consent and I have had the opportunity to question the contents and my therapy. By signing this form, I confirm my consent to treatment and I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment. I am aware that the most updated version of our policies are available on our website at https://steprightfootclinic.com/our-policies/
• Service/visit fees may be covered by a private health care plan however I understand that it is my responsibility to know the details of my private health care plan coverage and that direct billing is a service that is offered and may be withdrawn at any time without notice.

Electronic Transmission Authorization & Benefit Assignment Policy

I authorize the insurer and / or plan administrator and their service provider(s) to: use my personal information for the above purposes. exchange personal information with any individual or organization, including healthcare professionals, investigative agencies, insurers and reinsurers, and administrators of government benefits or other benefits programs when relevant for the above purposes. exchange personal information concerning any claims submitted with the plan member or a person acting on behalf of the plan member. exchange personal information for the above purposes electronically or in any other manner.

I understand that personal information may be subject to disclosure to those authorized under applicable law.

I agree that a photocopy or electronic version of this authorization shall be as valid as the original, and may remain in effect for the continued administration of the group benefits plan.

Additional Consent Applicable to Plan Members Only

I confirm that I am authorized by my spouse and/or dependents, if any, to disclose personal information about them to the insurer and/or plan administrator and their service provider(s) for the purposes described above and I confirm that my spouse and/or dependents also authorize the insurer and/or plan administrator and their service provider(s) to disclose information about their claims to me, for the purposes of assessing and paying a benefit, if any, and managing the group benefits plan. I also authorize my spouse and/or dependents to assign benefit payments under the plan to the healthcare provider. In the event there is suspicion and/or evidence of fraud and/or plan abuse concerning claims submitted, I acknowledge and agree that the insurer and/or plan administrator and their service provider(s) may use and disclose relevant personal information to any relevant organization including law enforcement bodies, regulatory bodies, government organizations, medical suppliers and other insurers, and where applicable my Plan Sponsor, for the purposes of investigation and prevention of fraud and/or plan abuse. If there is an overpayment, I authorize the recovery of the full amount of the overpayment from any amount payable under the group benefits plan, and the exchange of personal information with other persons or organizations, including credit agencies and, where applicable, my Plan Sponsor, for that purpose.

I hereby assign benefits payable for the eligible claims to the Provider responsible for submitting my claims electronically to the group benefits plan and I authorize the insurer/plan administrator to issue payment directly to the Provider. In the event my claim(s) are declined by the insurer/plan administrator, I understand that I remain responsible for payment to the Provider for any services rendered and/ or supplies provided. I acknowledge and agree that the insurer/plan administrator is under no obligation to accept this Assignment, that any benefit payment made in accordance with this Assignment will discharge the insurer/plan administrator of its obligations with respect to that benefit payment, and that in the event the benefit payment is made to me, the insurer/plan administrator will also be discharged of its obligation with respect to that benefit payment. I understand that this Assignment will apply to all eligible claims submitted electronically by the Provider and that I may revoke it at any time by providing written notice to the insurer/plan administrator. If I am a spouse or dependent, I confirm that I am authorized by the plan member to execute an assignment of benefit payments to the Provider.

Cancellation Policy

We require 24 hours notice for any cancellations or changes to your appointment. An administrative fee of $50.00 will apply to cancellations with less than 24 hours notice, missed appointments, if more than 50% of the visit time has elapsed, or if the client has rescheduled more than 3 times for any individual visit. Cancellation notices may be provided to the clinic via email or phone, even if the notification is received outside of office hours. If repeated no shows occur, the clinic reserves the right to discharge you as a patient and provide you alternative clinics where you may receive care.

Orthopedic Supplies Policy

Orthotics:

Custom foot orthotics are medical devices made specifically for each patient and are non-refundable once manufacturing has begun. If a patient chooses not to proceed before manufacturing begins, a $100 non-refundable casting fee will apply. Orthotics must be picked up within 1 year of notification. After 1 year, uncollected orthotics will be disposed of without refund. Patients must notify their practitioner of any issues within 30 days of receiving the orthotics. There is a 3-month modification period, beginning on the manufacturing date and ending 90 days later, during which necessary adjustments can be made. Any modification requests made after 90 days may be subject to an additional fee.

Orthopaedic Shoes:

Orthopaedic shoes are non-refundable, even if unworn. Exchanges for sizing or quality issues only will be accommodated if the shoes are returned to the clinic within 30 days of notification that the items are ready for pickup. Shoes must be unworn and in original condition for an exchange to be considered. For patients requesting multiple exchanges which are unrelated to sizing or quality issues, a $15 restocking fee will apply per transaction.

Compression Stockings:

Compression stockings are medical garments sized specifically for the patient and are non-refundable. Exchanges for sizing or quality issues only will be accommodated if the clinic is notified within 30 days of notification that the items are ready for pickup. The clinic is not responsible if items are not picked up in a timely manner and the exchange period is missed.

I acknowledge that it is my responsibility to verify all private or third-party insurance coverage, including but not limited to: eligibility/requirements, coverage amounts, prescription requirements and submission deadlines. The clinic is not responsible for denied or partially paid claims, regardless of reason.

Patients may request written reports detailing clinical findings, recommended treatments or treatments provided for their employers or other third parties. The fee for written reports range from $10.00 to $40.00, depending on the length of the report. Patients also have a right to obtain copies of their medical records, either directly or through a duly authorized representative (e.g. legal counsel). Requests made by a representative must be accompanied by a signed consent form and the fee for providing copies of medical records is $20.00. 

Consent to Clinic Policies and Future Updates

I acknowledge that I have read, understood, and agree to abide by the clinic’s current policies and procedures, which include but are not limited to privacy, billing, cancellations, and consent to treatment. I understand that these policies may be updated from time to time. Patients will be notified of material changes to our policies either by email, clinic signage, or in-person communication. I understand that the most current version of the policies will be made available at www.steprightfootclinic.com/our-policies. I agree that it is my responsibility to review these policies periodically. My continued attendance at the clinic and receipt of services shall constitute ongoing agreement to the most current version of these policies.