We would like to thank you for choosing us for your medical needs. As one of our patients, we would like to keep you informed of the current office and financial policies for this establishment and all subsidiaries*

Please read each of the following sections carefully and initial:


This establishment and all subsidiaries* do NOT participate with any insurance companies. We are not able to bill your insurance and cannot accept payment from insurance for the services performed or prescriptions received. The medical providers do not use diagnosis codes or CPT codes, and because of this, we are unable to complete forms for patient reimbursement from insurance companies.


ALL PAYMENT IS EXPECTED AT THE TIME OF SERVICE, however, some services may require a deposit in advance. This establishment and all subsidiaries*only accepts payment in the form of cash, VISA, MasterCard, American Express or Discover. WE do NOT accept checks.



Our establishment and all subsidiaries* will provide patients with prescription medication and are subjected to state and federal laws. These laws do not permit us to restock sold items and accept returned prescription medications for refund. ALL SALES ARE FINAL. Before a service is performed please consider all the required protocols and side effects. We are committed to patient satisfaction and are available to answer any questions or concerns you may have in regards to the services we offer.


Broken appointments represent a cost to us, to you and to other patients who could have been seen in the time set aside for you. We require a 24 hour notice for canceling or rescheduling of any appointment. There is a charge of $25.00 for missed or late-canceled appointments. Excessive abuse of scheduled appointments may result in discharge from the practice.



Many of the medications that are prescribed by the medical providers of this establishment and all subsidiaries are deemed as controlled substances and must be monitored regularly. All patients are required to have an appointment with a medical provider in order to receive any prescription refills. The controlled medications will be dispensed in office at the time of your visit. If you choose, we can provide you with a written prescription to have filled at the pharmacy of your choice; however, a program fee will still apply.


Lab work is mandatory for all weight loss programs. I understand that my lab work needs to be completed within the first week following my initial appointment. I also understand that if the results are not received by this establishment prior to my second appointment, that I will not be prescribed any additional medication.


As in any procedure, treatment or program, there is no guarantee of any particular results. Results will vary based on each individual patient. 


I understand that this establishment and all subsidiaries* have the right to refuse treatment to and/or dismiss a client from any service, at any time. I also understand that I may not be a candidate for certain medical services and it is at the full discretion of the medical provider to determine whether I am a candidate for any service provided.


I have read, understand and agree to the office and financial policies set forth by this establishment and all subsidiaries*.








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