MD Predict Panel and MD Review Consent Form

I understand that Meakin Metabolic Care (MMC) is a virtual platform that is striving to lower the financial burden and inefficiencies of a typical medical practice to bring fellow Americans the best services to better their health.
I understand that the virtual platform does not allow for standard physical exams and other onsite procedures and inquiries that enhance findings and insights. I, therefore, understand I need to maintain a local physician and possible oncologist if appropriate to support my care.
I understand that the fees charged for these services are not covered by Medicare, Medicaid, or other insurance and MMC does not submit information for insurance approvals or referrals.
I understand that MMC strives to be efficient to lower the cost to their patients and therefore scheduling and interactions are done through the patient portal and website.
In keeping with our mission, MMC is uniquely mindful of the overwhelming nature of certain diagnoses and associated costs and has opportunities upon request to lower or eliminate fees.
I understand that metabolic management for disease prevention and cancer care enhancement is an evolving pattern of care and randomized trials for supplements and repurposed drugs used off-label are rarely available.
I understand MMC will offer customized pharmaceutical and supplement options and use laboratory values and known algorithms to optimize safety.
I understand it is my responsibility to submit the needed medical information to the portal and offer feedback at the evaluations to best enable MMC to offer safe care.
I understand that MMC is not set up to call and communicate with other physicians on a routine basis and it is the patient responsibility to review with their other physicians the care program offered by MMC and the associated medications and supplements.
I understand MMC will use best practices with lifestyle modifications applied to best tolerance to also support my course.
I understand I am not obligated to continue the care after initiation, and I proceed by my own choice.
I understand I can terminate this relationship at any time and MMC can terminate at any time as well.
I understand the challenging nature of virtual care and therefore will be understanding if electronics or Wi-Fi impact the schedule and be mindful of the time windows in the scheduling to best enable MMC to stay on track for other patients as well.
I understand the goals and purpose of MMC in the support of my health goals and am ready to proceed and consent to the evaluation and discussion of therapies using this format.

I agree.

My Products*

MD Predict Panel and MD Review

Health survey review and interpretation, Quest Lab order for MD Predict Panel and Cancer Screening Markers for non-cancer patients ($1600+ plus value), MD review and goal setting via Zoom (50 minutes), Supplement Recommendation and Prescription Sent In

$750.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Name

First NameLast Name

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Date of Birth

Date

MaleFemaleTransPrefer not to say

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Signature*