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  • NEW PATIENT FORM

  • Dr. Justin Marchegiani D.C.
    Phone: (512) 535-1817


    Dear Patient,

    Welcome! And thank you for choosing Dr. Justin as one of your healthcare providers.

    HOW THE PROCESS WORKS:

    Please click the "Save" button below before you start in case you can not complete the form in one sitting. Please take no more than 30 minutes to complete this form; all other details can be addressed at the new patient consult.

    STEP 1:
    During your initial consultation, Dr. Justin will review your health history and make recommendations for lab tests that are appropriate for your specific health issues.

    STEP 2:

    Once you have completed your lab tests, Dr. Justin will explain the meaning of your test results to you in a follow-up consultation. He will create an individualized therapeutic program for you, including diet changes, nutritional supplements, and exercise, lifestyle, and stress management advice.

    STEP 3:

    Subsequent consults are scheduled to monitor your progress. Dr. Justin will also design an ongoing wellness program to be reviewed and updated with our staff at no charge every six months. We invite you to contact us via email or phone should you have any questions during the course of your treatment.

    We look forward to assisting you in achieving your current wellness goals, and to guiding you in maintaining wellness throughout your life.

    You will automatically be enrolled in the clinic's weekly newsletter to provide you with free cutting-edge health information to support you on your health journey. If you wish not to receive the newsletter, feel free and unsubscribe.

    Send Over Your Labs:

    Please email your labs to office@justinhealth.com. Subject Line: Labs for "Patient's Full Name."

    Please name the lab test files you are emailing over like this: (Date of the test, your name, type of test). Example (5-5-17 John Smith blood test or stool test).

    This helps to sort through tests and review them faster at your consult.

    In Health,

    Dr. Justin and the Wellness Team!

  • NEW PATIENT FORM

  • New Patient Paperwork


    Please email your labs to office@justinhealth.com. Subject Line: Labs for "Patient's Full Name."

    Please name the lab test files you are emailing over like this: (Date of the test, your name, type of test). Example (5-5-17 John Smith blood test or stool test). This helps to sort through tests and review them faster at your consult. 

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  • Employment Status

  • Spouse Information

  • Please answer all questions frankly, to the best of your knowledge. All information is confidential.











  • Metabolic Assessment Form

  • Please circle the appropriate number on all questions below, 0 as the least or never to 3 as the most or always.

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  • Just In Health Policies & Procedures

  • Fee Schedule:

    New patient consultation with Dr. J $399, 45-60 minutes on average.

    New patient initial consultation (with new patient coordinator): $325 45-60 minutes on average.

    Follow-up consultations for existing patients only:

    • 45-60 minute follow-up: $299
    • 30-45 minutes follow-up: $225
    • 15-30 minutes follow-up $150
    • 1-15 minutes follow-up $80
    • 30-45 minute nutrition follow consult (Not with Dr. J) $175
       

    Payment is due at the time of consultation:

    • Payment methods include electronic money transfer, Visa, MasterCard, Discover, Amex and debit cards. Credit card information is securely stored in an encrypted format to ensure payment for services rendered.
    • Follow-up consultations will be billed for the actual time block used, not the time block you schedule. Many patients underestimate how much time is needed to address their concerns. The doctor will be focused on listening to the patient and unable to track the patient's time.
    • New patient consults may go longer depending on how in-depth or complex someone's medical history is.
    • After-hour follow-up consults for existing patients are $75 extra.

    Late Fees:

    A late fee of $5 per day will be applied to bills unpaid after 48 hours unless other accommodations have been made with the office. Click here for more info on our late fee policy.

    Appointments

    Follow-up consults may be scheduled in 15, 30, 45, or 60-minute blocks of time. We encourage you to book your appointments 4 weeks in advance. As a courtesy to you, our office will email you 3-7 days in advance to remind you of your appointment.

    Lab Tests

    The results of your lab test(s) will be sent to Dr. Justin 2 to 4 weeks after mailing your specimens to the lab Dr. Justin will evaluate the results. After evaluation, you will be contacted to schedule a follow-up appointment. Certain blood work can be billed to the patient’s insurance, this is dependent upon the type of insurance you have as well as your deductible. Cash discount options can be used to purchase blood work when insurance is unavailable. The patient is responsible for any lab work their insurance does not cover. 

    Some patients may have copious labs for Dr. J to review at the new patient consult. Dr. J can review 1-3 shorter lab tests within the new patient consult. There may be a lab interpretation fee between $100-$300, depending on the number of lab pages, to set aside time to review labs before the new patient consultation or follow-up consultation. 

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  • Cancellation Policy

    If you cannot keep your appointment, please reschedule online using the clinic's email software. For additional instructions, click here. The office requires at least 3 business days before your scheduled consult is canceled. A missed consult fee equal to the value of the appointment time scheduled will be charged.

    Dr. Justin has patients waiting over a month to be seen, and a missed appointment takes time away from other patients. We require at least 3 business days so we can use that time to help someone else get the care they need.

    As a courtesy, our scheduling service will email you an appointment reminder the day the appointment is made and 1-7 days in advance before your consult. We can not guarantee patients will receive these reminders because of email and spam filters. Not receiving a reminder email is not an acceptable excuse for a missed consultation. You can also mark these emails as friendly to increase your chance of receiving them.

    If The Doctor Is Running Late

    If the Doctor is running late you must be available for the entire consult time. The Doctor may be running late with his previous patient; you will be charged a missed consult fee equal to the consult's value if you are unavailable.

    Super-Bills

    All receipts given at checkout contain CPT codes and IC10 codes that can be submitted to your insurance company for reimbursement. The easiest way to do this is by calling the customer service number on the back of the insurance card to receive instructions regarding submitting your claim.

    The Doctor is not responsible for any insurance claims that are not reimbursed. If any super-bill changes need to be made, it is the patient's responsibility to find out from their insurance what needs to be amended. The office will adjust the super-bill at $5 fee per receipt. Any in-depth paperwork that requires the Doctor to fill out will be charged to the patient at the doctor's hourly rate.

    Any fraudulent chargeback claims will be disputed and sent to collections.

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  • Refunds & Returns

    • Please be aware that once purchased, all sales of supplements and laboratory tests are final. We are unable to offer refunds or exchanges for these items.
    • All ingredients for Dr. J's supplements can be found in the store as well. It's the patient's responsibility to ensure there are no specific allergens in the supplements before they are shipped; the best time to address this is during the supplement program design. 
    • There are no refunds for any serviced consultations. 
    • Any fraudulent chargeback claims will be disputed and sent to collections. 

    Important Notes

    • Dr. Justin is not a medical doctor and does not treat medical emergencies. Contact your primary care physician or dial 911 if you have a medical emergency.
    • Please contact the office if you are unclear on any of our policies or procedures.
    • Dr. Justin is not providing you with Chiropractic treatment.
    • Dr. Justin does not treat or diagnose any medical disease. Dr. Justin’s work is to help support physical and chemical stress imbalances with the goal of promoting wellness.
    • Patients are seen via phone or video mediums need to realize there are physical limitations of not seeing the doctor in person. Due to these physical limitations, it's important that a patient has seen their primary care physician in the last year for an in-person visit to rule out any disease pathologies as well as assess any health issues that may be limited via a virtual assessment. By signing below, I agree that I have and or will see a primary care physician, if I haven't yet, for an in-person consultation and examination.

    Communication Outside of Scheduled Consultation

    • Many people now use email as a primary way to communicate with others. We appreciate that email can be a great way to ask a quick question or clarify something from your last visit or share with us how you are doing. Yes or no questions are best with email correspondence. A question that doesn't involve a back on forth dialogue that can be answered in 1-2 sentences is also acceptable.
    • Through experience, however, we have found that email is often not the best way to deal with more treatment-oriented questions and decisions, such as questions regarding your medical issues, changes in your symptoms, or complex requests. Instead, in these cases, please schedule an appointment so your doctor will have time set aside to hear and address your concerns directly. If there is no time available on the calendar for a troubleshoot consult, please email and call the office so we can find a time to squeeze you in.
    • If you have sent us an email and have not heard back from us after several days, please follow up with a phone call.
    • Dr. Justin is not a medical doctor, for any medical emergencies please call 911. If you are in need of refills on prescription medication, please see the original prescribing physician.

    Shipping & Handling:

    • Within the mainland, U.S. orders are shipped via USPS Ground or Priority Mail, unless otherwise requested. If you require your order quickly, please ask for request expedited shipping to ensure your products arrive sooner.
    • Extra charges apply for orders shipped to Internation countries as well as  Hawaii and Alaska. Please e-mail if you have questions.
    • International orders are shipped by USPS Mail International Priority. Please contact the office for any international shipment requests. If you require expedited shipping, please e-mail for UPS Expedited Worldwide shipping charges. International shipping fees will be charged on a separate invoice once distance and weight costs can be calculated.
    • The clinic is not responsible for issues with shipping as long as the products are sent to the address approved by the patient in the previous invoice. The patient is responsible to make arrangements with the delivery services if there is an issue with the package, this includes lost or stolen packages as well.
    • The clinic is not responsible for any packages seized by customs.
      Products manufactured by Dr. Justin carry a 30-day limited warranty against defects. Any products missing from your order must be reported within the first week of receiving the order.
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  • Clinic Policies and Procedures

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  • Payment Authorization Form

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