Welcome to EdenMD Wellness! We thank you for entrusting us with your healthcare. Communication is at the center of our care, and this Patient Agreement (“Agreement”) explains how we will work together.
a. Services. As used in this Agreement, the term Services means Diabetes Care, Depression Care, Anxiety Care, Acute Illness Care, Education on Wellness and Lifestyle Medicine as delivered by Telehealth. Services do not include primary healthcare, and you are encouraged to maintain your relationship with your regular provider.
b. Scheduling. Your advance scheduling notice helps us provide the best possible experience for all of our patients.
i. Cancellations. Other than same-day appointments, we request that you provide us with a minimum of 24 hours’ notice if you are unable to attend a scheduled appointment. If we do not receive 24 hours’ notice, the fee you paid at the time of booking will not be refunded and will be considered a missed appointment fee.
Any cancellation of same day appointments will not be refunded.
ii. Medication Refills. Requests for medication refills are processed during normal business hours; not in the evening, on weekends, or holidays. Please be aware that it may take up to 3 business days to have your prescription refilled. Accelerated or after-hours refill requests may incur an additional administrative fee.
iii. Urgent Care Instructions. Practice operates during regular business hours and is not available for care that requires immediate or urgent attention. We kindly ask that you limit after-hours, weekend, and holiday communication to urgent situations that cannot wait until the next business day. If you are experiencing an urgent healthcare need that cannot wait up to 48 hours for a response, or the next regular business day including holidays, whichever is later, then you should immediately call or present at your local urgent care center.
iv. Emergency Care Instructions. If you are experiencing a medical or psychiatric emergency, you should immediately call 911 or visit your nearest emergency department. If you should ever need it, the National Suicide Prevention Hotline telephone number is (800) 273-8255.
c. Controlled Substances. We do not prescribe controlled substances on your behalf, including commonly abused opioid and other pain medications, certain muscle relaxers, benzodiazepines, and other stimulants.
d. Excluded Services. You may need the care of primary care providers, emergency rooms, outside laboratory testing, pathology studies, prescribed medications, radiologic imaging, specialist consultations or treatment, surgery, urgent care centers, specialty vaccinations, or other healthcare services that are outside the scope of this Agreement. We highly recommend that you maintain health insurance, which may or may not cover the cost of these services. We will endeavor to place orders for Excluded Services in a manner that is cost effective for you.
2. Consent to Treat. You acknowledge, consent, and hereby authorize Practice to carry out your healthcare treatment. Treatment includes but is not limited to: the administration and performance of all treatments, the administration of any needed anesthetics, the administration and use of prescribed medications, the performance of such procedures as may be deemed necessary or advisable for treatment, including but not limited to diagnostic procedures, the taking and utilization of cultures, and of other medically accepted laboratory tests, all of which in the judgment of the attending provider or their assigned designees may be considered medically necessary or advisable. You acknowledge and understand that this consent is given in advance of any specific diagnosis or treatment, that these services are voluntary, and that you have the right to refuse these services. You understand and intend this consent to be continuing in nature, even after a specific diagnosis has been made and treatment recommended. This consent will remain in full force unless revoked in writing and will not affect any actions that were taken prior to receiving your revocation.3. Privacy & Communications.
a. Your Privacy Rights. You acknowledge and hereby authorize Practice to use and/or disclose the health information that specifically identifies you, or that can reasonably be used to identify you, to carry out your treatment, payment, and healthcare operations. Practice will adhere to its obligations regarding your privacy rights as identified in Practice’s Patient Notice of Privacy Practices. Your signature on this Agreement attests that you have read, understand, and agree to our Notice of Patient Privacy Practices and that you have been given a copy of the Notice or opted to use a digital copy.
b. Methods of Communication. You acknowledge that Practice communications may include use of cell phones, e-mail, facsimile, instant messaging, and video (collectively, “Communications”). Communications by their nature cannot be guaranteed to be secure or confidential. If you initiate a conversation in which you disclose protected health information on any of these Communication platforms, then you authorize Practice to communicate with you regarding all protected health information in the same format. Communications technology and platforms are wholly outside of our control. Therefore, Practice and our providers shall not be liable to you, or anyone, for any cost, damage, expense, injury, or other loss relating to Communications, malfunctions, or delays in response. Your signature on this Agreement attests that you have read, understand, and agree to our Informed Consent for Telehealth and that you have been given a copy of such or opted to use a digital copy.4. Fees.
a. Valid Payment. In exchange for Services, you agree to pay Practice the fee for service then in effect at the time care is provided. Payment must be received prior to Services being rendered. You are required to provide a valid form of payment and if the form of payment provided expires or otherwise becomes invalid, you agree to promptly provide updated payment information. In the event there are costs associated with invalid payment information, including chargebacks and insufficient funds fees, such charges will be applied to your account and overdue accounts may be subject to interest. By signing this Agreement you are authorizing Practice to charge the fees described herein and in Practice’s Patient Policies & Procedures, and other fees charged to your account to the form of payment you provide and to use this form of payment to pay any and all amounts as those become due. This provision shall survive termination of this Agreement for any reason.
b. Non-Participation in Insurance. You acknowledge that neither Practice, nor its providers participate in any public or private health insurance or HMO plans. Neither Practice nor its providers make any representations regarding third party insurance reimbursement of fees paid under this Agreement, and such reimbursement is not anticipated by this Agreement. You are responsible for payment in full prior to or at the time Services are rendered.
c. Non-Participation in Medicaid. You specifically acknowledge that Practice and its physicians do not participate in any state Medicaid program. This means that Medicaid cannot be billed for any Services performed under this Agreement. Further, you agree not to bill Medicaid or attempt Medicaid reimbursement for any such services.
d. Non-Participation in Medicare. You specifically acknowledge that Practice and its physicians do not participate in the Medicare program. This means that Medicare cannot be billed for any Services performed under this Agreement. Further, you agree not to bill Medicare or attempt Medicare reimbursement for any such services. By signing this Agreement, you specifically acknowledge and agree that you are not currently a Medicare beneficiary and if you become a Medicare beneficiary in the future, you will promptly notify Practice and transfer your care to another provider.
a. This Agreement will commence on the date it is signed and will continue until it is terminated. b. Both you and Practice shall have the absolute and unconditional right to terminate this Agreement without cause. c. If Practice elects to terminate this Agreement, we will provide you with thirty (30) days’ written notice, or any such other time necessary to transition your care to another provider. d. There are certain circumstances in which we may choose to immediately terminate this Agreement including without limitation:
i. You relocate outside our service area. ii. Failure to adhere to Practice’s Policies & Procedures. iii. Failure to pay Fees and charges when they are due. iv. Failure to sign other required documentation, as applicable. v. Failure to adhere to the recommended treatment plan. vi. Repetitive missed appointments or failure to provide adequate notice of cancellation. vii. You are abusive, disruptive, or present an emotional, physical, or other danger to the wellbeing of patients, providers, staff, or others. viii. Practice discontinues operation.e. Enforcement.
In the event of a determination by any federal, state, or local regulatory or enforcement agency that the arrangement herein contemplated is unlawful or noncompliant with regulatory requirements, then this Agreement shall be automatically reformed to the minimum extent necessary for conformity with law and regulation. If this Agreement cannot be so reformed, then it shall automatically terminate as of the date first triggering the adverse determination. In such a case, this Agreement shall be automatically replaced by Practice’s relevant conforming agreement.6. Miscellaneous.
a. Amendment. This Agreement may be amended by Practice from time to time. Your continued engagement of Services will acknowledge your agreement to subsequent amendments.
b. Default. In the event of your default under this Agreement, Practice will be entitled to costs reasonably related to such default. c. Dispute Resolution. The parties shall endeavor to amicably resolve any disputes arising under this Agreement. If such internal resolution is not effective, each party agrees that final disposition of the dispute shall be resolved by binding arbitration and enforced by any court of competent jurisdiction. Notwithstanding anything to the contrary, small claims court actions brought by Practice shall be exempt from the requirements of this provision.
By signing this Agreement, you specifically understand, acknowledge, and agree that any dispute as to medical malpractice or professional negligence will be determined by submission to binding arbitration and not by a lawsuit or resort to court process with or without a jury, except as to judicial review of arbitration proceedings. The provider of arbitration services shall be made solely at Practice’s discretion, costs of arbitration shall be borne equally by the parties, and each party shall be responsible for their own attorneys’ fees at the trial level and upon appeal, unless Practice is the prevailing party in the dispute in which case it shall have the right to recoup its reasonably related expenses from the non-prevailing party. Practice operates in a number of jurisdictions, and your state may have particular arbitration rules including time to have this Agreement reviewed by your legal counsel and/or recission of your consent for arbitration as the sole method for dispute resolution. The provisions and requirements of the governing state’s laws are incorporated by reference as though fully set forth herein and you specifically waive any right that would controvert this arbitration requirement due to any rule of construction or imperfection as to form including the disclaimer and notice language appearing on the signature page. This Agreement, and specifically this arbitration provision, shall be interpreted so that it is in conformity with relevant law and any non-conformity shall be automatically revised to the minimum extent necessary to achieve conformity.
d. Governing Law. EdenMD Wellness is a limited liability company domiciled in Arizona. This Agreement shall be subject to and governed by the laws of Arizona, without regard to any conflicts of law provisions therein contained and the parties specifically waive any and all jurisdictional rights under the laws of any other state.
e. Grammar and Headings. Unless the context otherwise requires, the singular shall include the plural and the plural may refer only to the singular. The use of any gender shall be applicable to all genders. Capitalized terms used in this Agreement shall have the definitions provided. The captions and headings for each provision of this Agreement are included for convenience of reference only and shall not be deemed to modify, restrict, or enlarge any of the terms or provisions of this Agreement.
f. Integration. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes any and all other oral or written agreements, representations, negotiations, and understandings.
g. Notices. Any notices or payments required or permitted to be given under this Agreement shall be deemed given when in writing, by electronic transmission, hand delivered, or delivered by traceable carrier with postage prepaid, to the other party at the address set forth herein or as the parties may otherwise designate in writing. All notices shall be deemed delivered as evidenced by verified digital date stamp, on the date of hand delivery, or the date of receipt provided by traceable carrier.
h. Remedies. All powers, remedies, and rights (“Remedies”) granted to Practice by any particular term of this Agreement are cumulative and in addition to, but not in limitation of, any Remedies that it has under any other term of this Agreement, at common law, in equity, by statute, or otherwise. All such Remedies may be exercised separately or concurrently, in such order and as often as may be deemed desirable by Practice.
i. Severability. In the event that any provision of this Agreement is held to be illegal or unenforceable for any reason, the unenforceability of that provision shall not affect the remainder of this Agreement, which shall remain in full force and effect in accordance with its terms, and any offending provision shall be rectified to the minimum extent necessary for conformity with law unless it cannot be rectified in which case this Agreement shall be interpreted as though the offending provision had not existed.
If this Agreement is held to be invalid or unenforceable for any reason, and if Practice is therefore required to refund all or any portion of the Fees paid by you, you agree to pay Practice an amount equal to the fair market value of the Services actually rendered to you during the period of time for which the refunded fees were paid commensurate with prevailing rates in the Practice service area.
j. Survival. Any provisions of this Agreement creating obligations extending beyond the term of this Agreement shall survive the expiration or termination of this Agreement, regardless of the reason for such termination.
k. Waiver. No waiver of a breach of any provision of this Agreement will be construed to be a waiver of this Agreement, or any other provision herein contained, whether of a similar or different nature, and no delay in acting with regard to a breach shall be construed as a waiver of that breach.
Telehealth is the practice of healthcare using electronic communication or other information technology when you and your healthcare provider are in different locations. Generally, healthcare providers can only treat patients who are physically located in the state where the provider is licensed. In some cases, healthcare providers can treat patients who are in-state residents, but are temporarily located out-of-state (e.g., on vacation). Telehealth communications may include e-mail, facsimile, SMS/text/instant messaging, telephone, and video conferencing, and may be used on a variety of telephonic or electronic devices (collectively, “Communications”). Your signature memorializes your informed consent and authorization for Practice and its providers to use Telehealth in the course of your care. By signing this Informed Consent and/or the underlying agreement, you acknowledge and understand the risks and benefits of receiving Telehealth, and you agree to the following terms of service.
a. Telehealth should never be used in an emergency or urgent care situation. If you experience a medical or psychiatric emergency, you must immediately call 911 or your local emergency department. You must seek urgent care when you need it, and you must not rely on Telehealth for urgent health needs. If you prefer in-person
appointments instead of Telehealth, please tell your provider, and Practice will accommodate your request or refer you to another provider. Declining to receive
Telehealth on a specific occasion will not impact your access to Telehealth in the future.
b. Your provider has absolute discretion, at all times, to determine the suitability of delivering Telehealth. If your provider determines that a different form of healthcare services are appropriate (e.g., an in-person office visit), then your provider may discontinue. Telehealth and will provide instructions and/or referrals for you to receive the recommended care.
c. Telehealth has certain benefits, but it also has certain limitations and risks. In some cases, the transmitted information may be insufficient to allow for appropriate healthcare decision-making by your provider (e.g., poor image resolution). If your provider does not have access to information that would be apparent or available in a face-to-face visit, the use of Telehealth may result in medical error or misjudgment. Delays can result from equipment deficiencies or failures. No results can be guaranteed, and you are always free to seek a second opinion. Telehealth never limits your ability to seek in-person care.
d. At each Telehealth session, you must be physically located in the state in which your provider is licensed. If you are temporarily out-of-state but maintain in-state residency, you must notify your provider before a Telehealth session commences. Your provider may not be able to issue prescriptions, referrals, or other orders if you are out of state. You may need to seek local care for these and other healthcare needs.
e. You will cooperate with your provider at each session to assess the suitability of Telehealth. This may include verification of your identity, location, and readiness to 8 OF 16 proceed. Telehealth requires that you be in a situation conducive to private, undistracted, and uninterrupted Communications. If your health issue is of a sensitive nature, make sure you can receive Telehealth in a private space so others in your space cannot see, hear, or intercept your session.
f. You can revoke this Telehealth Informed Consent at any time; however, your participation in Telehealth and Communications includes your implied consent. If you
revoke your consent, you must notify your provider and Practice in writing as soon as possible, and the revocation will not be effective until it has been received and
acknowledged by your provider.
a. Communications by their nature cannot be guaranteed to be secure or confidential. Telehealth and Communications involve some risk that unauthorized persons or entities
may see, access, copy, or use your personal information. There is some risk that unencrypted Communications could be intercepted in transmission or redirected to a
third party not authorized to receive the information. If you initiate a conversation in which you disclose protected health information on any Communication platform, then you authorize your provider and Practice to communicate with you regarding all protected health information in the same format. Communications technology and platforms are wholly outside the control of your provider and Practice. Therefore, your provider and Practice shall not be liable to you, or anyone, for any cost, damage, expense, injury, or other loss relating to Communications malfunction, or delay in response.
b. Prior to receiving Telehealth, you must understand how Communications work and you need to be comfortable using them. You must have the devices, tools, and
telephone/internet access necessary to receive Telehealth, and you are responsible for the security of these elements. It is your responsibility to encrypt medical information that you transmit electronically to your provider and failure to use technical safeguards, such as encryption, increases your risk of a privacy violation. The risk of a violation of your privacy increases substantially when you enter information on a public access computer, use a computer that is on a shared network, allow a computer to store usernames and passwords, or employ a work computer for personal use. You fully accept these risks and responsibilities.
c. If Communications fail during the course of a Telehealth session, you must immediately try to contact your provider using another method of communication. For example, if a video conference is disrupted by connectivity issues, you should call your provider on the telephone. Your session will then resume, or you and your provider may decide to reschedule. Under no circumstances should you allow a health need to remain unaddressed because of Communications issues.
a. Practice will adhere to its obligations regarding your privacy rights as identified in the Notice of Patient Privacy Practices. You attest that you have read, understand, and agree to the Notice of Patient Privacy Practices and that you have been given a copy of the Notice or opt to use a digital copy.
b. All Telehealth must be documented. With your permission, Communications may be videotaped or otherwise recorded. If you permit Telehealth sessions to be recorded, the resulting data, including audio, image, and video files, may become part of your health record.
c. The laws that affect your patient privacy are the same for Telehealth for in-person care. Among other considerations, this may include access that your health insurer will have to your records for quality review and audits.
Effective January 1, 2022
EdenMD Wellness has developed this Notice of Patient Privacy Practices to help you understand how medical information about you may be used, disclosed, and how you can get access to this information. Please review this notice carefully. If you have any questions or concerns, please contact Privacy Officer Ruth Forde, M.D. at 7760 E State Route 69, Ste C5-342, Prescott Valley, Arizona, 86314, Email: [email protected], Phone: (602) 525-8530.
You have the right to:
• Get a copy of your paper or electronic medical record.
• Correct your paper or electronic medical record.
• Request confidential communication.
• Ask us to limit the information we share.
• Get a list of those with whom we’ve shared your information.
• Get a copy of this privacy notice.
• Choose someone to act for you.
• File a complaint if you believe your privacy rights have been violated.
You have some choices in the way that we use and share information if we:
• Tell family and friends about your condition.
• Provide disaster relief.
• Include you in a hospital directory.
• Provide mental health care.
We may use and share your information as we:
• Treat you.
• Run our practice.
• Bill for your services.
• Help with public health and safety issues.
• Do research.
• Comply with the law.
• Respond to organ and tissue donation requests.
• Work with a medical examiner or funeral director.
• Address workers’ compensation, law enforcement, and other government requests.
• Respond to lawsuits and legal actions.
• Laws vary from state to state, but adult patients always have a right of access to their medical records, and in many cases, minors have a right of access for any medical record pertaining to healthcare for which the minor is legally authorized to grant consent. Your state laws will determine whether parents or guardians may be granted access to records arising from the consent of a minor.
• If you are or become incapacitated, we may disclose relevant medical information to a family member, other relative, domestic partner, a close personal friend of yours, or any other person identified by you as being involved in your care or payment for your care.
• All medical information transmitted during the delivery of health care via telehealth/telemedicine/virtual care will become a part of your medical records.
When it comes to your health information, you have certain rights. This section explains those rights.
Get an electronic or paper copy of your medical record.
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record.
• You can ask us to correct health information about you that you think is incorrect or
incomplete. Ask us how to do this.
• We may say “no” to your request, but we will tell you why in writing within 60 days.
Request confidential communications.
• You can ask us to contact you in a specific way (for example, home or office phone), or to
send mail to a different address.
• We will agree to reasonable requests.
Ask us to limit what we use or share.
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it could affect your care.
• 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.
Get a list of those with whom we’ve shared information.
• You can ask for a list (an accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated.
• Please let us know if you feel we have not upheld our obligations. Contact us using the information on page 1 of this Notice.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and the choice to tell us to:
• Share information with your family, close friends, or others involved in your care.
• Share information in a disaster relief situation.
• Include your information in a hospital directory.
If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
• Marketing purposes.
• 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.
TWe typically use or share your health information in the following ways:
• We never market or sell personal information.
• We can use your health information and share it with other professionals who are treating you.
• We can use and share your health information to run our practice, improve your care, and contact you when necessary.
• We can use and share your health information to bill and get payment from health plans or other entities.
We are allowed or required to share your information in other ways, usually in ways that contribute to the public good. * We have to meet many legal obligations before we can share your information for these purposes that include:
Government Requests: We can use or share health information about you:
• For workers’ compensation claims.
• For law enforcement purposes or with a law enforcement official.
• With health oversight agencies for activities authorized by law.
• For special government functions such as military and national security.
Legal Actions: We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Legal Compliance: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
Medical Examiners & Funeral Directors: We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Organ and Tissue Donation: We can share health information about you with organ procurement organizations.
Public Health & Safety:
• Preventing disease.
• Helping with product recalls.
• Reporting adverse reactions to medications.
• Reporting suspected abuse, neglect, or domestic violence.
• Preventing or reducing a serious threat to anyone’s health or safety.
Research: We can use or share your information for health research.
* For more information visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
• We are required by law to maintain the privacy and security of your protected health information.**
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this Notice and give you a copy of it.
• We will not use or share your information other than as described in this Notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
• We can change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.
**For more information visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Effective January 1, 2022
Payment for Services: EdenMD Wellness is a Fee-For Service Telehealth practice with virtual office visits conducted via video or phone. Payment is due at the time of booking. Your appointment will not be confirmed unless payment is received prior to your visit. We do not participate in or bill any public or private your health insurance plan. Federal law does not permit us to provide services to Medicare beneficiaries.
Services and Fees:
EdenMD Wellness sees patients for Diabetes Care, Depression Care, Anxiety Care, , Acute/Sick Visits, Lifestyle Medicine, and Prescription Refills.
We do not serve as primary care providers. All patients are encouraged to maintain a relationship with their primary care provider for regular primary care and chronic condition management.
Once paid, all fees are NON-REFUNDABLE. The Services listed below are only for care provided directly by EdenMD Wellness. Fees for labs, radiology/imaging, other tests, referrals, etc. will be billed separately to you by that provider and are your responsibility.
Practice operates during regular business hours and is not available for care that requires immediate or urgent attention. We kindly ask that you limit after-hours, weekend, and holiday communication to urgent situations that cannot wait until the next business day. If you are experiencing an urgent healthcare need that cannot wait up to 48 hours for a response, or the next regular business day including holidays, whichever is later, then you should immediately call or present at your local urgent care center.
Acute or Sick Visits: Same day illnesses or a lingering sense of not feeling well can often occur and you may not be able to get in to see your regular doctor. We see patients for common acute issues such as but not limited to: UTI symptoms, Vaginal symptoms, Headache, Skin Rash, Tooth pain, Respiratory symptoms, Sore throat, Ear pain, and COVID related questions. $99 per visit.
Acne: We see patients for problematic acne that is new or chronic. $99 per visit.Diabetes Care: We help with the diagnosis, management of diabetes as well as pre-diabetes and address prevention, treatment and possible reversal. $99 each visit. Depression and Anxiety Care: We can help with diagnosis and management of depression/anxiety; perhaps all you need is a listening ear in a comfortable and non-judgmental atmosphere. We can help. $99 each visit.
Prescription Refills: If you are unable to see your primary care doctor in time, we may be able to provide you with medication refills (maximum of 30 days’ supply per visit.) $99 per visit. WE DO NOT PRESCRIBE or REFILL CONTROLLED SUBSTANCES, INCLUDING NARCOTICS, BENZOs LYRICA, GABAPENTIN, and CERTAIN MUSCLE RELAXERS.
Communications: Please keep your contact information (phone number, email, mailing address) up to date with us at all times and let us know of changes as soon as possible. To protect your privacy, we prefer and encourage you to use our Patient Portal to communicate with us outside of office visits.
Missed Appointments. Other than for same-day appointments, we request that you provide us with a minimum of 24 hours’ notice if you are unable to attend a scheduled appointment. If we do not receive 24 hours’ notice, the fee you paid at the time of booking will not be refunded and will be considered a missed appointment fee.
Late Policy: If you are late, your appointment will still end at the regularly scheduled time. If you arrive at your appointment more than 5 minutes late, your tardiness may be deemed a late cancellation at the discretion of the physician.
Medical Forms or Letters: Any forms or letters outside the scope of the visit may be provided at the sole discretion of the physician and will incur additional charges from the regular appointment fee. You will be made aware of this fee and payment will be collected prior to the documentation being performed.
Minors: We treat patients aged 13 and above. State laws regarding the informed consent for medical treatment of minors will apply. Similarly, the state laws that determine whether a parent or guardian has a right to access the records of a minor will also apply.