1. Initial* All office visits, telemedicine, or consultations that have been completed and the patient has been seen by a provider are non-refundable. 2. Initial* Telemedicine office visits are available through Fort Wayne Integrative Medicine and Fort Wayne Primary Care. Telemedicine appointments are not available through the following insurances: Ambetter, CareSource, Healthy Indiana Plan, Indiana Medicaid (traditional), MD Wise, and MHS.3. Initial* After each appointment, the patient will receive an individualized treatment plan for reference.4. Initial* Patients must be available 30 minutes before their telemedicine (Fort Wayne Integrative Medicine only) or an in-person appointment for the Medical Assistant to review the patient's medical history (triage). The Medical Assistant will contact the patient with 2 telephone calls and 1 email to confirm the appointment and to ensure the video conference link is properly working. If the patient is unavailable, they will forfeit their deposit and will need to reschedule their appointment.5. Initial* A list of prescriptions, dosing and frequency must be provided at each appointment. Any prescriptions not provided at the original appointment; the patient will need to schedule a follow-up appointment for the additional prescription(s) to be refilled. 6. Initial* Prescription refills are issued to both compounding and retail pharmacies. Patients must allow 48 hrs. (2 business days) for retail refills and 72 hrs. (3 business days) for compounding refills to process within our office. After this timeframe, patients are required to contact their pharmacy to confirm the refill has been completed. Due to insurance regulations, any Primary Care patient(s) needing compounding prescriptions will be required to schedule an appointment under the Fort Wayne Integrative fee schedule. 7. Initial* Periodically insurance companies will require a Prior Authorization for medications, imaging, or other services. Our office will submit the forms, however if the Prior Authorization is denied and the insurance company requests a Peer-to-Peer review, we cannot accommodate this request. We apologize for any inconvenience.8. Initial* Any provider communication is available only during regular business hours via email or phone. Correspondence is intended for brief questions regarding your most recent visit. Any detailed questions will require an office visit.9. Initial* A deposit must be made at the time of scheduling for Fort Wayne Integrative Medicine patients (Only). This deposit is for office visits focused on Compounded medications. Hyperbaric Oxygen therapy, Laser Liposuction, and BHRT Pellet therapy must be paid upfront. Primary Care patients are not required to leave a deposit unless their service is for Fort Wayne Integrative treatments (Listed above) Deposit reimbursement for scheduled office visits is available if canceled before 72hrs. (3 business days) of appointment time. If cancelations or rescheduling occur after 72hrs, the patient will forfeit their deposit. Balance is due at the time of appointment. 10. Initial* Hyperbaric Oxygen Therapy cancelations or rescheduled appointments require 72 hours (3 business days) advance notice. If this timeframe is not met, there is a $50 fee, this fee also applies to missed appointments. A refund for Hyperbaric Oxygen Therapy sessions is permitted up to 10 business days after purchase. After 10 days a 50% Office Credit will be issued. Some exceptions may be allowed but will require Office Manager approval.11. Initial* Please refer to our BHRT information and pricing at FWIMED.com/providerfees. BHRT pellet therapy pricing may vary based on dosage. A superbill will be provided per patient request for out-of-network insurance billing for office visits and BHRT pellet therapy. Bioidentical Hormone Pellet therapy will require bloodwork for the first two pellet insertions. Once symptoms have stabilized bloodwork will only be required annually.12. Initial* We ask that all patients pay if administering these specific lab requests. If the patient refuses cash payment for Lipoprotein A, Homocysteine, Vitamin D, Ferritin, hs-CRP, Fort Wayne Integrative Medicine, or Fort Wayne Primary Care will not facilitate insurance coverage, CPT codes or the balance due after labs have been drawn and processed by the patient's insurance. These lab requests are routinely denied payment by insurance companies.13. Initial* Interest accrues at the rate of one percent per month for any amounts remaining unpaid for more than ninety (90) days following the date of the service. Our practice accepts Cash, Cashier Checks, Credit Cards (Mastercard, Visa, American Express and Discover), FSA and HSA cards. No personal checks.14. Yes No* Fort Wayne Primary Care and Fort Wayne Integrative Medicine maintain a social media presence which can include photographs of patients, patient's families, and therapy sessions. Inclusion for the social media presence is strictly voluntary and is not endorsed or compensated. To enable Fort Wayne Primary Care and Fort Wayne Integrative Medicine to include a photo for our social media page or print materials, we require a signature. I waive any rights to inspect and approve the finished product or copy. 15. Initial* Fort Wayne Primary Care and Fort Wayne Integrative Medicine offer appointments and lab reminders by directly texting patients. Patient information will not be shared or published.