Tearing
Risk Management

Can “Terms of Service Agreements” Reduce Refund Battles?

Patients often don't understand that chiropractic care is both a science and an art, and like all health care, there are no guarantees that treatment will be successful.


Consequently, some patients request refunds when their chiropractic care expectations are unmet. They think they shouldn't have to pay for chiropractic services or products (e.g., supplements) that didn't provide the anticipated result.

This is a situation in which a terms of service agreement may be beneficial. These agreements can help manage treatment expectations and clarify the patient’s payment responsibility. What’s more, they provide proof to credit card companies that the patient agreed to pay for care, if the patient later disputes a credit card payment made to the chiropractor.

The agreements vary in terms of content, but they typically have the patient acknowledge that they understand that:

  • Services and products offered in a chiropractic practice are treatments, and there is no guarantee as to their success.
  • Payments are the patient’s responsibility, regardless of insurance compensation or the effectiveness of care.
  • The practice will not provide refunds for payment of services provided or products purchased.
  • The patient is responsible for any copays or other out-of-pocket expenses.

Many doctors find terms of service agreements are also beneficial in reducing possible malpractice risk. Beyond establishing care expectations, the agreements can serve as a good segue into an informed consent discussion in which patients are apprised about the nature of the treatment; the risks of treatment; alternative treatments and their risks; and the hazard of not being treated. Additionally, service agreements may help patients improve their own health, if the agreement outlines suggested behavioral and lifestyle modifications.


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.