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Skip to contentPrivate Pay & Payment Policy
Pacific Recovery Retreat is a private-pay concierge nursing service and does not directly bill or submit claims to insurance providers. To reserve and secure services, a 20% deposit is required at the time of booking. The remaining 80% balance is due in full no later than 14 calendar days before the scheduled start date of service. For example, if services are scheduled to begin on June 15, the remaining balance must be paid by June 1. Reservations requested within 14 calendar days of the scheduled start date may require payment in full at the time of booking. All deposits, payments, cancellations, and refunds are subject to the terms outlined in the applicable Service Agreement and governed by applicable law.
Client Forms
Required Form
Client Intake Form
Basic details, contact and emergency contact.
Required Form
Consent for Use
Conditions, allergies and current medications.
Required Form
Notice of Privacy Practices
Pacific Recovery Retreat is committed to protecting
Required Form
Consent for Care
Authorization for concierge nursing services.
Required Form
Surgery Information Form
Procedure, surgeon, facility and date.
Required Form
Service Agreement
Terms, cancellation policy and applicable fees.
Required Form
Payment Authorization
Deposit and balance payment details.
Required Form
Medication Management
Schedule and support for post-op medications.
Required Form
Transportation Request
We provide transportation to and from doctors
Reservation & Payment
To reserve your recovery services, a 50% nonrefundable deposit is required at the time your forms are submitted.
The remaining balance is due at least two weeks prior to your scheduled surgery date.
Please note that reservations made within the same week as your requested start date, as well as reservations occurring during holidays, may be subject to additional fees due to limited availability and staffing requirements.
To ensure the best availability and avoid potential additional fees, we strongly encourage you to reserve your recovery care well in advance.
Your Recovery, Our Priority
At Pacific Recovery Retreat, we believe recovery should be more than simply getting through the days following surgery. It should be a time to feel supported, comfortable, safe, and cared for.
From attentive nursing support to the thoughtful details that make your stay more comfortable, our team is dedicated to creating a personalized recovery experience centered around comfort, dignity, privacy, and peace of mind.
By completing your forms and securing your reservation in advance, you allow our team to thoughtfully prepare for your arrival and create a care experience tailored to you.
Thank you for trusting Pacific Recovery Retreat with such an important part of your healing journey. We look forward to providing the compassionate, elevated care you deserve.
Thank you for trusting Pacific Recovery Retreat with such an important part of your healing journey. We look forward to providing the compassionate, elevated care you deserve.
Pacific Recovery Retreat
Personalized Care. Peaceful Recovery. Exceptional Comfort.
Questions About Your Forms?
Our team is here to help you with the paperwork and preparation process.
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