1. During the course of treatment, I may undergo procedures in all phases of healthcare, wellness and prevention. Some of the procedures may be performed by a physician's assistant, nurse or medical assistant other than the doctor including any medical professional that has been trained to perform certain tasks that is allowable by Florida law.
2. I will provide a thorough and complete medical history, supply a full list of my medications with dosages, and consent to my doctor communicating with my other medical practitioners to inquire about any aspect of my health history.
3. No guarantees can be made about treatment outcomes, restoration longevity, or prognoses. I understand that any branch of medicine, including wellness and prevention, can involve unanticipated results.
4. Payment is due the day of service and I am responsible for the full amount owed regardless of any insurance policy I may or may not have. I understand that The Q Institute is a cash only practice and the only amounts possibly covered by insurance would be discussed with me before the procedure and submitted to my insurance company with no guarantees of coverage. The practice will help in filling any forms needed for insurance reimbursement and those payments will be given to the patient. There is no guarantee that an insurance company will cover work that may be performed.
5. My treatment plan may change at any time and I will do my best to approach my medical care with optimism and open communication with my doctor and the medical office staff.
6. I am welcome to ask questions about any aspects of my medical care and will request information if I am confused or need more information. I am responsible for clarifying any aspects of my treatment that I am unsure about.