Personal Evolution Memberships

Membership Benefits

The Personal Evolution Membership is designed for those who want to make ongoing care and energy balancing a core part of their lifestyle. As a member, you receive:

• Regular NetworkSpinal Care sessions as outlined in your chosen membership plan.

• Participation at Energy Immersion Events held multiple times per year.

  • Discounts on additional Energy Immersion Events.

• Two 30-minute consultations per year for personalized guidance.

• 50% savings on additional consultations and wellness evaluations as needed.

• Discounts on other intuitive energy healing modalities provided at Evolve Holistic Center.

Membership Policies

• Cancellation Policy: You may cancel your membership at any time with written notice. I reserve the right to discontinue a membership if practice policies are not followed.

• Sessions Do Not Carry Over: To maximize the benefits of care you are encouraged to use every visit in your plan. Unused sessions do not roll over to the following month.

• Refunds and Flexibility: If unforeseen circumstances prevent you from using your membership, accommodations or refunds may be offered on a case-by-case basis.

• Exclusions: The membership covers holistic and energetic care but does not include conventional chiropractic adjustments, which are available separately.

• Notice of Updates: Members will receive notice via email regarding any updates to the membership policies.

• Integrity and Fairness: If an unforeseen situation arises that is not covered in this policy, I will always strive to approach it with fairness and integrity.

• Agreement Acknowledgment: By enrolling in the membership, you acknowledge that you have read and agree to these policies. Evolve Holistic Center reserves the right to update policies as needed with prior notice.

I am honored to provide care that supports your continued evolution and growth. If you have any questions about memberships, care plans, or how to best integrate this work into your life, I’m happy to connect and discuss the best path forward for you.

Paying for Your Care

I believe in full transparency when it comes to the cost of care. You will never be charged for any services without a clear understanding of your financial responsibility. I do not accept insurance payments of any kind.

There are no billing codes established for NetworkSpinal Care, and because this care is not a treatment for a diagnosed condition, it is not covered by health insurance plans. However, if you wish to contact your insurance carrier about coverage, you may ask if they will reimburse NetworkSpinal under the “97139 – unlisted therapy code.” If so, I can provide a superbill along with a supporting document explaining the procedures and the use of the unlisted therapy code and the application of this care approach to support your optimal healing.

Payment for services and products at Evolve Holistic Center is due at the time of service or through prepayment plans. You may keep a card on file in your secure patient portal (processed through Square) for automatic payments, or you may choose to pay via cash, check, or other transactions accepted by Square. Receipts are available in the patient portal, and printed receipts can be provided upon request.

• All services are non-refundable once provided.

• Full refunds are available upon request for any prepaid services that have not yet been used.

• Care and payment plan agreements are not binding contracts and may be canceled at any time. If you choose to cancel a care plan, you are welcome to return for a re-evaluation and a new plan at any time.

I accept CareCredit financing, which allows for interest-free payment plans for up to three months of care at a time. Details about CareCredit financing are available below.

I also accept Bitcoin, Ethereum, Chainlink, and XRP (aka Ripple) forms of Crypto Currency. On occasion I may accept organic, natural foods from organic food producers/ranchers/hunters as barter for care. 

Cost of Care

• Initial Visit with Spinal Wellness Evaluation: $150–$250 (depending on time required for medical record review or additional testing)

• Progress Evaluations: $75

• NetworkSpinal Care Appointments: $60

• Additional Consultations: $50 per 15 minutes

• Chiropractic Adjustments: $60 for 1–2 spinal regions, $75 for 3–4 regions

• Extremity Adjustments: $30

• Manual Muscle Testing & Muscle Therapies: $90 per 30 minutes

If NetworkSpinal Care is provided in combination with other chiropractic adjustments, the fee for NetworkSpinal is reduced by $40 due to overlapping exam components of the care.

Special Rates & Memberships

• Household Family Members: Children (ages 0–17) receive a 30% discount on NetworkSpinal Care while a parent is also receiving care.

• Personal Evolution Memberships: Members receive significant savings on NetworkSpinal Care and access to special events and services.

• Hardship & Charitable Rates: I reserve the right to offer reduced rates on an individual basis while also maintaining the financial health of my practice to continue serving others.

CareCredit Financing Options

CareCredit allows for financing of care plans with no interest if paid within the promotional period.

• Transactions over $200 may qualify for 6-month interest-free financing.

• Transactions over $400 may qualify for 12-month interest-free financing.

• After the promotional period, an APR of 26.9% or greater applies to the full transaction amount if it is not paid in full during the promotional period.

• CareCredit can be used for up to 90 days' worth of services at a time but cannot be used as one-time payments for longer-term care plans.

For more information, visit CareCredit Online or ask for a brochure in the office.

I am committed to making care as accessible as possible while ensuring the highest level of service. If you have any questions about payment options or financing, please feel free to ask.

I believe in a shared decision-making process when it comes to your health. You have the right to be fully informed about the condition of your health and the care I recommend so that you can make empowered choices. This document is designed to provide you with all the necessary information to help you make an informed decision about receiving care at Evolve Holistic Center.

Understanding NetworkSpinal Care

At Evolve Holistic Center, I offer a specific form of spinal care known as NetworkSpinal® (NS). NetworkSpinal Care is an evidence-based approach to wellness and body awareness that is taught exclusively to chiropractors. It provides a unique application of spinal care designed to enhance the connection between your brain and body, ultimately leading to greater well-being.

Many individuals who receive NS Care report profound shifts in their lives, including significant emotional experiences that coincide with the release of long-standing stress and tension. While I cannot guarantee specific outcomes, I do encourage you to approach this care with an open mind, as it may lead you to experience your body and life in a completely new way.

Acknowledgements

I request and consent to receiving spinal care, including wellness education, from Dr. Jason Dixon, DC, at Evolve Holistic Center. Dr. Jason provides NetworkSpinal (NS) Care, a gentle and highly specialized approach with unique clinical outcomes. He chooses to practice NS because he is both professionally and personally confident in its safety and effectiveness.

Care in this office is provided in alignment with the Council on Chiropractic Practice Guidelines and the Canon of Ethics of the Association for NetworkSpinal Care. Dr. Jason has extensive training in both traditional chiropractic care and NetworkSpinal Care, ensuring a comprehensive approach to spinal health and wellness.

This consent form serves to clarify the nature of the services provided, our shared responsibilities, and the expectations of care. By understanding these elements, we can foster a stronger practitioner-client relationship and create a healing environment that supports your personal growth and well-being.

What to Expect from NetworkSpinal Care

NetworkSpinal Care is different from traditional chiropractic adjustments. It does not involve manual or instrument-based manipulations that create a popping or cracking sound. Instead, it enhances your body’s awareness of itself, helping you develop new strategies for healing, adapting to stress, and improving overall wellness. Through this process, your body can naturally self-correct and self-regulate spinal tension patterns, supporting your innate ability to heal.

NS Care consists of gentle touch contacts along specific points on your spine, particularly in the neck and back. These light touches help establish greater communication between your brain and body, creating new sensory and motor patterns. This approach aligns with somatic (body/spinal awareness) training and has been extensively researched, with documented benefits for overall wellness. If you are interested in learning more, I can provide access to published research articles and abstracts. You can also visit the Chiropractic and Network Spinal Page on this site to explore more about this care. Additional resources from the developer of NetworkSpinal Care are available at https://epienergetics.com/welcome-networkspinal.

Progress and Assessments

As part of your NS Care, I will assess your spinal and body awareness, responsiveness to tension and ease patterns, and ability to engage with your own healing process. Regular reassessments will be performed to track changes in your nervous system integrity and self-regulation capabilities. I will share observations about how your spine and nervous system are evolving through this process.

NS Care progresses through different levels, each involving the development of unique spinal wave motions, spontaneous movements, and internal reorganizational patterns. These spinal waves contribute to greater spinal stability, energy redistribution, and deeper internal awareness. Research suggests that these processes support enhanced well-being, a higher quality of life, and greater overall life enjoyment.

Additional Assessments and Education

Beyond NS Care, I may conduct additional assessments and provide guidance tailored to your specific needs. This could include spinal evaluations, lifestyle recommendations, or other supportive care approaches.

It is important to understand that the care provided at Evolve Holistic Center is not a substitute for traditional medical diagnosis or treatment. Instead, it is a form of wellness care designed to empower you with greater body awareness, self-regulation, and healing strategies. Through NS Care, your body can learn to release and redirect tension in a way that is unique to this approach.

Common Responses to Care

It is common for individuals receiving NS Care to experience deep, spontaneous breathing, changes in posture, and a release of tension during or after a session. Many also report feeling more energized, more present in their bodies, and more connected to their inner life force. At times you may experience the tension your body is holding more intensely as your nervous system is reorganizing to a more efficient way of being.

You may notice increased emotional expression, shifts in movement patterns, and even profound changes in your lifestyle choices. These are all natural responses as your body reorganizes itself in healthier, more sustainable ways.

Is NS Care Right for You?

This form of care is not intended for individuals who seek to simply remove a symptom without undergoing deeper personal transformation. At Evolve Holistic Center, my goal is not just to help you return to a previous state of health but to guide you toward an entirely new level of wellness and life potential.

By choosing NS Care, you are committing to a process that can open doors to greater vitality, deeper self-awareness, and profound shifts in your overall well-being. I look forward to being a part of your journey to a more empowered, connected, and thriving life.

NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Our Legal Duty

We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information.  We must abide by the terms of this Notice while it is in effect.  However, we reserve the right to change the terms of this Notice and to make the new notice provisions effective for all the protected health information that we maintain.  If we make a change in the terms of this Notice, we will notify you in writing and provide you with a paper copy of the new Notice, upon request.

 Uses and Disclosures

There are a number of situations in which we may use or disclose to other people or entities your confidential health information.  Certain uses and disclosures will require you to sign an acknowledgement that you received this Notice of Privacy Practices.  These include treatment, payment, and health care operations.  Any use or disclosure of your protected health information required for anything other than treatment, payment or health care operations requires you to sign an Authorization.  Certain disclosures that are required by law, or under emergency circumstances, may be made without your Acknowledgement or Authorization.  Under any circumstance, we will use or disclose only the minimum amount of information necessary from your medical records to accomplish the intended purpose of the disclosure.

We will attempt in good faith to obtain your signed Acknowledgement that you received this Notice to use and disclose your confidential medical information for the following purposes.  These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided Consent.

Treatment.  Example: We may use your health information within our office to provide health care services to you or we may disclose your health information to another provider if it is necessary to refer you to them for services. 

Payment.  Example: We may disclose your health information to a third party such as an insurance carrier, an HMO, a PPO, or your employer, to obtain payment for services provided to you.

Health Care Operations.  Example: We may use your health information to conduct internal quality assessment and improvement activities and for business management and general administrative activities.

Appointment Reminders.  Example: Your name, address and phone number and health care records may be used to contact you regarding appointment reminders (such as voicemail messages, postcards, or letters), information about alternatives to your present care, or other health related information that may be of interest to you.

In the following cases we never share your information unless you give us written permission: Marketing purposes, sale of your information, most sharing of psychotherapy notes. In the case of fundraising:  We may contact you for fundraising efforts, but you can tell us not to contact you again.

There are certain circumstances under which we may use or disclose your health information without first obtaining your Acknowledgement or Authorization:

Those circumstances generally involve public health and oversight activities, law-enforcement activities, judicial and administrative proceedings, and in the event of death.  Specifically, we may be required to report to certain agencies information concerning certain communicable diseases, sexually transmitted diseases, or HIV/AIDS status.  We may also be required to report instances of suspected or documented abuse, neglect, or domestic violence.  We are required to report to appropriate agencies and law-enforcement officials information that you or another person is in immediate threat of danger to health or safety as a result of violent activity.  We must also provide health information when ordered by a court of law to do so.  We may contact you from time to time to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.  You should be aware that we utilize an “open adjusting room” in which several people may be adjusted at the same time and in proximity.  We will try to speak quietly to you in a manner reasonably calculated to avoid disclosing your health information to others; however, complete privacy may not be possible in this setting.  If you would prefer to be adjusted in a private room, please let us know and we will do our best to accommodate your wishes.

Others Involved in Your Healthcare:  Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care.  If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.  We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition, or death.  Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.

Communication Barriers and Emergencies:  We may use and disclose your protected health information if we attempt to obtain consent from you but are unable to do so because of substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances.  We may use or disclose your protected health information in an emergency treatment situation.  If this happens, we will try to obtain your consent as soon as reasonably practicable after the delivery of treatment.  If we are required by law or as a matter of necessity to treat you, and we have attempted to obtain your consent but have been unable to obtain your consent, we may still use or disclose your protected health information to treat you.

EXCEPT AS INDICATED ABOVE, YOUR HEALTH INFORMATION WILL NOT BE USED OR DISCLOSED TO ANY OTHER PERSON OR ENTITY WITHOUT YOUR SPECIFIC AUTHORIZATION, WHICH MAY BE REVOKED AT ANY TIME.  Except to the extent disclosure has been made to governmental entities required by law to maintain the confidentiality of the information, information will not be further disclosed to any other person or entity with respect to information concerning mental-health treatment, drug and alcohol abuse, HIV/AIDS or sexually transmitted diseases that may be contained in your health records.  We likewise will not disclose your health-record information to an employer for purposes of making employment decisions, to a liability insurer or attorney as a result of injuries sustained in an automobile accident, or to educational authorities, without your written authorization.

 Patient Rights

Right to Request Restrictions.  You may request that we restrict the uses and disclosures of your health record information for treatment, payment and operations, or restrictions involving your care or payment related to that care.  We are not required to agree to the restriction; however, if we agree, we will comply with it, except with regard to emergencies, disclosure of the information to you, or if we are otherwise required by law to make a full disclosure without restriction. Your request must be made in writing to our Privacy Official. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Right to Receive Confidential Communications.  You have a right to request receipt of confidential communications of your medical information by an alternative means or at an alternative location.  If you require such an accommodation, you may be charged a fee for the accommodation and will be required to specify the alternative address or method of contact and how payment will be handled. Your request to receive confidential communications must be made in writing to our Privacy Official.

Right to Inspect and/or Copy.  You have the right to inspect, copy and request amendments to your health records including electronic health records.  Access to your health records will not include psychotherapy notes contained in them, or information compiled in anticipation of or for use in a civil, criminal, or administrative action or proceeding to which your access is restricted by law.  We will charge a reasonable fee for providing a copy of your health records, or a summary of those records, at your request, which includes the cost of copying, postage, and preparation or an explanation or summary of the information.  Your request to inspect and/or copy your health information must be made in writing to our Privacy Official.

Right to Amend.  You have the right to request that we amend certain health information for as long as that information remains in your record. Your request to amend your health information must be made in writing to our Privacy Official and you must provide a reason to support the requested amendment.

Right to Receive an Accounting.  You have the right to inspect, copy and request amendments to your health records.  Access to your health records will not include psychotherapy notes contained in them, or information compiled in anticipation of or for use in a civil, criminal, or administrative action or proceeding to which your access is restricted by law.  We will charge a reasonable fee for providing a copy of your health records, or a summary of those records, at your request, which includes the cost of copying, postage, and preparation or an explanation or summary of the information.  Your request to receive an accounting must be made in writing to our Privacy Official. 

Right to Receive Notice.  You have the right to receive a paper copy of this Notice, upon request. We are obligated to notify you if there is a breach of your PHI unless there is a low probability of PHI compromise.

 Complaints

You may file a written complaint to us or to the Secretary of Health and Human Services if you believe that your privacy rights with respect to confidential information in your health records have been violated.  All complaints must be in writing and must be addressed to the Privacy Officer (in the case of complaints to us) or to the person designated by the U.S. Department of Health and Human Services if we cannot resolve your concerns.  You will not be retaliated against for filing such a complaint.

All questions concerning this Notice or requests made pursuant to it should be addressed to: Privacy Officer, Evolve Holistic Center, 5801 Curzon Ave, Ste 213, Fort Worth, TX 76107.   Effective date of this notice: 05/09/2023

PAYMENT POLICY for SERVICES & PRODUCTS

Payments for all services provided and products purchased at Evolve Holistic Center (EHC) are due at the time services are provided and products are given to you. We do not ship products sold in our office.

When using a debit or credit card to make your payments:

-We accept all major credit cards using Square

-You may pay for services at the time they are rendered by using our self checkout kiosk or allowing us to keep your card on file in our secure patient portal (processed through Square).

-No credit card information is ever kept on physical or digital media at EHC or on any of EHC’s servers.

We also accept cash or personal checks. ($35 fee is charged for any checks that are returned as NSF)

PRIVACY POLICY

We respect and are committed to protecting your privacy. We may collect personally identifiable information when you visit our site. We also automatically receive and record information on our server logs from your browser including your IP address, cookie information and the page(s) you visited. We will not sell your personally identifiable information to anyone.

SECURITY POLICY

Your payment and personal information is always safe. Our Secure Sockets Layer (SSL) software is the industry standard and among the best software available today for secure commerce transactions. It encrypts your personal information so that it cannot be read over the internet.

REFUND POLICY

Prepayment for services at Evolve Holistic Center simplifies your experience in our office, and may qualify you for discounts on services. Any payments you make to our office for services in advance to the receipt of those services are applied as a credit to your account with EHC. All account credit is held in escrow until services are rendered.

In the event of a need to cancel/discontinue a course of care that you have prepaid for: any refunds for services which have not been rendered will be provided as a credit to the credit card used at the time of purchase within seven (7) business days of the request. If refunds to the card cannot be made, we will issue a refund with a check. There are no penalties which would reverse care plan special pricing when a refund is requested, though cancellation of a discounted care plan will prevent eligibility for future plan discounts.