Patient Information Form T&Cs

Health Insurance and Payments #

We are usually happy to invoice those health insurers with whom we are contracted, although this will not affect your liability as you remain responsible for the payment of our fees in full. In order to take advantage of this service you will need to provide us with your insurance membership / policy number, policy renewal date and a valid pre-authorisation code. We will also need your credit / debit card details prior to your appointment, which will be stored via our PCI compliant payment system Square. We are unable to provide treatment unless you provide card details and sign these terms & conditions.

Please note that even if you have health insurance, it may not cover all our fees and expenses. Certain treatments and items may not be covered by your insurer, or there may be an excess payable. We will require that you pay any balance if your insurance company does not cover the full cost of treatment. If we receive notification from your Insurer that you have an excess on your policy, your funds have been exhausted, or they refuse to pay any outstanding fees in full for any reason, these fees will be charged directly to your debit / credit card on file. If your insurance company operates a Cost Share’ arrangement with you, we will automatically take this payment from the card details you provide to us as soon as we are notified about the arrangement and thereafter on the day of subsequent appointments and a receipt will be emailed directly to you. If your insurer has not paid us in full within 30 days and our agreement with your insurer does not outline terms for delayed payments, we will require payment from you directly and reserve the right to debit your credit or debit card accordingly. We will provide you with a receipt to reclaim this charge from your insurer, and you should contact your insurer directly if you have any queries at all with regards your claim.

Direct Payments #

If you are not covered by an insurance company that we invoice directly or are paying for your appointment yourself, you will be required to pay the full cost of your treatment in advance of each appointment. We are unable to provide treatment if your appointment is not paid for in advance and in full. Payment can only be made by credit / debit card (we do not accept cash or cheque), and we will provide you with a receipt to reclaim this charge from your insurer if applicable. A range of pre-paid treatment packs are available for some services; please ask reception for further details. All prepaid treatment packs are valid for a period of 12 months from their date of purchase — apart from the Physio Follow-Up Extended 6 & 10 packs which must be used within 3 and 6 months respectively — and are non-refundable and non-transferable. If you are choosing to pay by Direct Debit, should you cancel the Direct Debit for any reason, you will be required to settle any outstanding balance via a one-off payment immediately. For patients that have been referred by a Health & Fitness provider with which we have a direct agreement and to which you have already made a payment for our services, we will invoice the Health & Fitness provider directly.

Late Payment #

We charge interest on late payments at 2% a year over the Bank of England base rate. You will be liable for all costs of collecting or enforcing payment from you. We may cancel or suspend treatment if our fees and expenses are not paid in full when due.

Cancellation Policy #

We require at least 24 hours’ notice from you if you need to cancel or amend an appointment. For appointments with our Strength and Conditioning or Nutrition team, the cancellation notice period is 48 hours. For appointments with ours Sports and Exercise Medicine Consultants (SEM’s), the cancellation policy is 48 hours. Appointments cancelled within these time frames will be charged at full value and cannot be submitted to your insurer.

Referrals #

Occasionally we may refer you to a third party for further treatment or imaging. We will send a referral letter to that third party and you will be responsible for arranging your appointment with them. You will be bound by the terms and conditions of that third party and we undertake no liability with respect of that third party.

Consent to Treatment #

We are aware that many medical and therapeutic problems, procedures and treatments can be confusing for patients. It is important that you fully understand our diagnosis and recommendations, the procedures and treatments that may be involved, and their likely effects. We make every effort to ensure that we communicate effectively, but please make sure you ask us if you are uncertain of anything or would like any further information. You must make us aware of any factors that could affect your treatment or our diagnosis. A copy of correspondence will be sent to your GP unless you state otherwise. If you are covered by health insurance, we may also share medical information with your insurer unless you state otherwise.

Our Use and Disclosure of Your Data and Health Records #

Pure Sports Medicine operates in accordance with the General Data Protection Regulations (GDPR). Your medical records will be stored electronically and accessed by
authorised personnel only. Disclosures may be made to health professionals, including your GP and certain third parties that need access to them to provide health care services to you (for example, imaging services). Pure Sports Medicine may use your medical information on a strictly anonymous basis for teaching, research
and audit purposes.

Under the GDPR medical information which relates to you is considered special category data. This means that in addition to having a lawful basis for processing
this data (required for all data processing), we are required also to satisfy a separate condition for processing special category data. There are 10 categories under GDPR including where the processing is necessary for the purpose of medical diagnosis or provision of healthcare. We rely on performance of our contract with you as our grounds for processing your medical data, and rely on provision of healthcare as our condition for processing such special category data. For further information on how we look after your data please see our privacy policy which you can access on our website: pure​s​portsmed​.com/​l​e​g​a​l​/​p​r​i​v​a​c​y​-​p​olicy. Please
also feel free to ask us for more information with regards to data protection, your health records and related rights if you are unsure.

Our Liability #

We do not accept liability for loss of, or damage to, patients’ personal possessions while in our clinics unless the loss or damage can be proved to have been caused
by an employee of Pure Sports Medicine. We do not accept liability for death or personal injury unless proved to have been caused by the negligent act or omission of Pure Sports Medicine or its employees. Your statutory rights are not affected.

Access and download the full Patient Information Form

Patient Information Guide