Welcome To Our Family

Thank you for taking the first step toward proactive, personalized care. I look forward to working with you to build a wellness plan tailored to your unique risks and goals.

Once we receive this form, we’ll schedule your initial lab visit, which includes a fasting blood draw and a carotid artery ultrasound (CIMT). Results take a few weeks, so we’ll meet three weeks later to review everything together.

Required genetic testing through Boston Heart is $100, and additional optional tests are available for $25 each. These are not included in the membership and are typically not covered by insurance.

Some services are covered by your membership, others are billed to insurance, and a few may have out-of-pocket costs. We’ll always let you know in advance if that’s the case. Your insurance provider determines any remaining balance based on your coverage.

Wellness is a journey—and I’m here to guide you through it.

Welcome to the Apex family.

-Deirdre Detraz, ANPC

 

• Access to our prevention program rooted in the BaleDoneen Method

• Annual CIMT ultrasound to detect hidden arterial plaque

• Convenience of in-office lab draws

• Customized wellness plan based on your lab, genetic, and lifestyle data

• Ongoing risk monitoring for inflammation, metabolic health, and vascular disease

• Dedicated time with your provider for in-depth care planning and education

• Care coordination with specialists when needed

Single Patient Membership Fees:

Type	Frequency	Amount
Annual	Once	$750
Bi-Annual	Every 6 months	$394
Quarterly	Every 3 months	$206
Monthly	Every month	$72

Family Discount Membership Fees Per Person:

Type	Frequency	Amount
Annual	Once	$650
Bi-Annual	Every 6 months	$341
Quarterly	Every 3 months	$179
Monthly	Every month	$62

Our services will be billed to your insurance. Your out-of-pocket costs will depend on your specific plan, and may include co-pays, deductibles, or non-covered services.

*You are responsible for any portion not covered by your insurance.

We partner with third-party labs for all testing: Boston Heart Diagnostics, Crescent City Surgical Center, and Quest Diagnostics.

*These labs handle their own billing, and charges will depend on your specific insurance coverage.

• Required Testing: A set of 3 genetic tests from Boston Heart Diagnostics is required at a cash price of $100 (not covered by insurance).
• Inflammatory testing is also conducted through Boston Heart Diagnostics.
• General lab work is processed through Crescent City Surgical Center.
• Urine samples are processed through Cleveland Heart Labs (Quest Diagnostics).

Patient Demographics

Apex Prevention, LLC		Deirdre Detraz, ANP-C
207 N Luke St.		Ph 337-739-7278
Lafayette, LA 70506		Fx 337-419-0533

Please note: in the event an ACH payment is returned for insufficient funds or any credit card transaction is declined, the appropriate accountholder will be notified by Apex Prevention, LLC. All such instances must be resolved within ten (10) business days, including any fees incurred by Apex as a result. Apex reserves the right to represent any payment and may require an alternate method of payment for future charges.

How likely are you to doze off or fall asleep in the following situations?

The Practice is a comprehensive prevention clinic designed to assess, maintain and improve the arterial health of its patients to the extent possible. We believe it is never too early to proactively address cardiac health through comprehensive assessments, monitoring, nutrition counseling, and innovative treatments.

The Practice employs clinically developed evidence-based protocols, including the BaleDoneen Method, that seek to not only prevent further progression of vascular disease but to also improve the patient’s vascular wellness and reduce the occurrence of heart attacks and ischemic strokes. As with any health care service, even the most comprehensive clinical protocols cannot guarantee certain outcomes or improvements. Our innovative approach strives to reduce the likelihood and severity of heart disease and improve overall heart health by addressing the root causes of the disease and implementing an individualized precision preventive plan of care responsive to clinical evidence of even subtle deviations of vascular wellness.

Initial evaluation and continual monitoring consist of extensive laboratory testing of inflammatory biomarkers, advanced lipid panels, genetic testing, metabolic health, oral pathogens, hormones, and ultrasound of carotid arteries to assess intima medial thickness and possible subclinical atherosclerosis. Each patient’s individualized preventive protocols are continually assessed and updated to address the patient’s health and responses to treatments as well as implement the latest clinical and scientific research. We also collaborate with national leaders on the prevention of cardiovascular disease.

The Practice is not a substitute for your primary care provider. The Practice is not designed to care for a patient’s primary, routine, or non-cardiovascular health needs. Rather, the Practice will work with a patient’s primary care provider to help facilitate the patient’s overall health. If you do not currently have a primary care provider, we are happy to make recommendations for providers if you would like.

I. PURPOSE OF AGREEMENT:

The Practice has developed a comprehensive cardiovascular care model that emphasizes preventive care services under the direction of Deirdre Detraz, ANP-C (Practitioner) and Staff. In exchange for certain fees paid by the Patient, as explained below, the Practice agrees to ensure the availability of specified enhanced services (Concierge Services) by the staff and Practitioner under the terms of this Agreement. Patient agrees that they have reviewed and understand the Patient Notice, attached hereto as Exhibit B.

II. CONCIERGE SERVICES:

1. Included Services: Concierge Services shall consist of the following Medical and Non-Medical Services:
   • Development of customized precision preventive cardiology plan of care
   • Enhanced access to the Practice’s multi-disciplinary healthcare team
   • Access to in-office nutrition counseling
   • The convenience of in-office blood draws and specimen collections;
   • Appointments pursuant to practice’s on-time appointment policy
   • Extended and unrushed time with healthcare practitioner during appointments
   • Focused patient education to periodically update Patients on the latest
   • Developments in cardiac care.
2. Excluded Services: The Concierge Service Fee will entitle Patient to receive the Concierge Services specifically included in this Agreement. Concierge Services shall not include any medical or other services covered by Patient’s private or federal program health insurance (“Insurance”). Any medical services covered by Patient’s Insurance will be paid for by the Patient and/or the Patient’s Insurance. The Patient remains responsible for any co-pays, co-insurance and/or deductibles associated with such Insurance.
3. Practitioner and Practice reserve the right to revise this list of Concierge Services upon thirty (30) days written notice to the Patient.
4. NOT INSURANCE: Patient acknowledges that this Agreement is not an insurance plan, and not a substitute for health insurance or other health plan coverage (such asmembership in an HMO). The Concierge Services only includes those additional amenities and conveniences listed in this Agreement and has no impact on and does not provide coverage for hospital services or any other services not personally provided by the Practice or the Practitioner. Patient acknowledges that Practice and Practitioner have advised patient to obtain or maintain appropriate health insurance that will cover Patient for medical and other related coverage. Practice will bill Medicare or private insurance for any covered services provided to Patient, including office visits and diagnostic tests. Patient’s co-pay, deductible and other financial obligations will still apply to covered services.

III.TERM AND TERMINATION:

The initial term of this Agreement shall begin on the Effective Date and shall continue for one year. The Agreement will automatically renew for additional one year terms unless either party provides the other party written notice of its desire to not renew the Agreement at least thirty (30) days prior to the end of the term. Patient agrees that Patient may only terminate the Agreement upon non-renewal.

IV.CONCIERGE SERVICE FEE:

1. In exchange for the Concierge Services listed herein, Patient hereby agrees to pay the Practice Concierge Service Fees
2. Patient agrees to make such payments timely by submitting payment prior to the start of the applicable time period. If payment is not received prior to the start of the applicable time period, Patient’s participation in the Concierge Services program will be automatically suspended until the Practice receives the required payment for the time period.

V.CONFIDENTIALITY OF HEALTH INFORMATION:

Information related to the Patient’s Concierge Services provided hereunder shall be considered part of the Patient’s Protected Health Information and subject to the same confidentiality protections under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and implementing regulations, as updated.

VI. OTHER PROVISIONS:

1. Change In Law: If there is a change of any law, regulation, or rule, federal, state, or local, which affects the Agreement or the activities of either party under this Agreement, or any change in the judicial or administrative interpretation of any such law, regulation, or rule, and either party reasonably believes in good faith that the change will have a substantial adverse effect on that party’s rights or obligations under this Agreement, then that party may, upon written notice, require the other party to the enter into good faith negotiations to renegotiate the terms of this Agreement. If the parties are unable to reach an agreement concerning the modification of this Agreement within the earlier of thirty (30) days after the date of the notice seeking renegotiation of the effective date of the change, or if the change is effective immediately, then either party may immediately terminate this Agreement by written notice to the other party.
2. Severability: If for any reason any provision of this Agreement is deemed by a court of competent jurisdiction to be legally invalid or unenforceable, the invalid provision shall be deemed modified to the minimum extent necessary to make that provision legally valid and enforceable while the rest of the Agreement shall remain enforceable.
3. Assignment: Patient may not transfer this Agreement or any rights Patient may have pursuant to this Agreement to any other party.
4. Amendment: An amendment of this Agreement is valid only if it is made in a writing signed by each party. Notwithstanding the foregoing, the Practice may unilaterally amend this Agreement to the extent required by federal, state, or local law or regulation (Applicable Law) by sending Patient written notice of any such change at least thirty (30) days prior to the effective date of the change. Any such changes are incorporated in this Agreement without the need for the parties’ signatures. Moreover, if Applicable Law requires this Agreement to contain provisions that are not expressly set forth in this Agreement, then, to the extent necessary, such provisions shall be deemed incorporated and part of this Agreement by reference as though such provisions had originally been set forth in the Agreement and agreed to by the parties.
5. Legal Document: Each party acknowledges that this Agreement is a legal document that creates certain rights and responsibilities. Patient also acknowledges having had a reasonable time to seek legal advice regarding the Agreement and freely enters into the Agreement.
6. Arbitration: If the parties are unable to resolve a dispute under this Agreement, the parties hereby agree to submit the dispute or controversy to binding arbitration for resolution before a single arbitrator. Such proceedings shall be conducted utilizing the procedural rules adopted by the arbitrator chosen by the Practice. Such proceedings shall be held in Lafayette, Louisiana. The parties agree that the prevailing party shall be awarded attorneys’ fees by the arbitrator.
7. Governing Law: This Agreement shall be governed by and construed under Louisiana law.