Office Policies

• Patient Responsibility: You are encouraged to ask questions on any health-related topic and to take an active role in your health-care.

• Confidentiality: Information revealed during office visits is confidential. Your record and the information contained within it will not be disclosed to others unless you direct us to do so in writing. Exceptions to this confidentiality include disclosure of the intent to harm yourself or others and subpoena from specific government agencies (as outlined in the HIPAA Privacy Rule).

• Treatment Plan: Each treatment plan and/or procedure possesses both risks and benefits. You are encouraged to ask questions if you would like additional information. Although your plan will be thoroughly researched and customized to your individual personal goals and health status, no guarantees can be assured regarding the outcomes of treatment plan(s) or procedure(s).

• Office Visits: Office visits are billed at $200.00 per hour. The first office visit is $400.00 and is typically 2 hours long. This length may vary. If a longer visit is necessary, you will notified of this prior to your appointment. Subsequent follow-up visits are a minimum of 30 minutes. There is no refund for services provided. You may be eligible for out-of-network insurance reimbursement or tax deduction for medical services.

• Insurance: We do not accept any insurance. All fees are settled directly between patient and provider. At the patient’s request, we will provide you with the necessary forms and diagnostic codes needed for you to submit an out-of-network claim to your insurance. Please note that we are are not Medicare providers and are opted out of the Medicare program. Our services can not be submitted to Medicare for reimbursement.

• Payment: We accept cash, money orders and most major credit cards. Checks are not accepted.

• Cancellation policy: When an appointment is scheduled, time is reserved especially for you and no one else. Since our appointments are much longer than standard office visits, cancellations are significant interruptions to the Clinic. Thus, a minimum of 3 days’ notice is required for cancellations of new patient visits and 1 day notice for existing patients. There will be a 100% office visit charge for “no-shows” or late cancellations.

• Specialty Laboratory Testing: Our clinic frequently uses specialty testing. These are usually an out-of-pocket expense. Occasionally, there is some insurance coverage. We will guide you through identifying the costs associated with your testing.

• Treatment Plan Questions: We encourage patients to call or e-mail with questions regarding their treatment plan. If there is a need for longer discussion regarding new symptoms or new concerns, then we recommend you schedule an additional follow- up appointment. Questions that require longer than 5-minute responses fit this scenario. Additionally, if it has been longer than 8 weeks since your last appointment, schedule an appointment rather than email.

• Emergencies and after-hours care: The Clinic is not a primary care clinic – we offer consultative services only. You must have a primary care doctor with whom you can consult in the event of an emergency or urgent problem. If you notice an adverse effect from one of the components of your Clinic treatment plan, you should discontinue it then email or call the Clinic during normal business hours. If you have a serious health problem that requires immediate attention, you should call your other doctors(s), call 911, or have someone take you to the nearest hospital emergency room.

• Please email us at info@swfunctionalmedicine.com for any questions regarding this policy.