KINOFIT SERVICE PACKAGES KinoFit Packages Enrollment Name * Name First Name First Name Last Name Last Name Email Phone Date of Birth * Custom Package Details Total Cost Performance Membership - Select One (If applicable) Individual Performance Membership – 8 sessions/month, 60 min ($480/month) Couples Performance Membership – 2 members, 8 shared sessions/month, 75 min ($720/month) Performance Guest Pass / Drop-In ($40/session) Adult Physical Therapy – Pay Per Visit - Select One (If applicable) Initial PT Evaluation + Initial Treatment ($150) Individual Follow-Up Visit ($123.60) 4-Visit Adult Rehabilitation Package ($460 / $115 per visit) 8-Visit Adult Rehabilitation Package ($856 / $107 per visit) 12-Visit Adult Rehabilitation Package ($1,188 / $99 per visit) Youth Physical Therapy – Pay Per Visit - Select One (If applicable) Youth PT Evaluation + Initial Treatment ($123) Youth Individual Follow-Up Visit ($100) 4-Visit Youth Rehabilitation Package ($380 / $95 per visit) 8-Visit Youth Rehabilitation Package ($680 / $85 per visit) 12-Visit Youth Rehabilitation Package ($900 / $75 per visit) KinoFit Signature Programs - Select One (If applicable) Recovery Wellness Membership – 4 visits/month ($240/month) Performance Wellness Membership – 8 visits/month ($480/month) Custom Wellness Membership – customized visits (Contact KinoFit for pricing) *KinoFit Signature program visits may be scheduled for physical and massage therapy. KinoFit Adult Rehabilitation Plans (Monthly) - Select One (If applicable) PT Essentials – 2 PT visits/month ($230/month) PT Progress – 4 PT visits/month ($428/month) PT Restore – 8 PT visits/month ($792/month) Post-Operative Recovery – 12 PT visits ($1,188 total) 12-Visit Youth Rehabilitation Package ($900 / $75 per visit) KinoFit Adult Rehabilitation Plans (Monthly) - Select One (If applicable) KinoFit Restore 90-Day Program – 28 PT visits, 12 weeks ($2,380, or 3 monthly payments of $793.33) Transition to Wellness Program – 16 sessions, 60 days ($960, or 2 monthly payments of $480) Signature - By signing below, patient agrees to the following terms: • This package is valid only while the patient keeps scheduled appointments and follows the recommended visit frequency listed above; results and package benefits depend on consistent attendance. • Auto-pay is available for all packages and is required for select packages as indicated above. Auto-pay will be charged automatically according to the payment plan selected. • A $25 cancellation fee will be applied after the first missed appointment or any cancellation made without at least 48 hours' notice. Exceptions may be made for documented emergencies at KinoFit's discretion. • Package fees are for services rendered at KinoFit Physical Therapy, PLLC and are non-transferable unless approved in writing by a KinoFit administrator. • Unused sessions and package terms are subject to KinoFit Physical Therapy's current cancellation, refund, and rescheduling policies, available upon request. signature keyboard Clear Submit If you are human, leave this field blank.
