Women HRT Membership

I understand that participation in the Hormone Optimization Program through Bottumzup Health and Wellness, LLC includes medical evaluation, ongoing monitoring, prescription management, laboratory review, and follow-up care.

HORMONE OPTIMIZATION PROGRAM FEES-Bottumzup Health and Wellness, LLC

Initial Consultation
$150 (one-time fee)

Includes:
• Comprehensive hormone evaluation
• Detailed symptom review
• Personalized treatment plan
• Laboratory recommendations and review

MONTHLY MEMBERSHIP

Standard Membership
$125/month

Weight Loss Program Member
$100/month
(Discount available while actively enrolled in a qualifying weight loss program.)

MEDICATION REFILLS Medication refills may be provided in 30-day, 60-day, or 90-day supplies at the discretion of the provider and based upon clinical appropriateness, treatment stability, laboratory monitoring, and applicable regulations. 

IMPORTANT--WHAT'S INCLUDED IN YOUR MEMBERSHIP

• Comprehensive hormone management
• Ongoing symptom monitoring and treatment adjustments
• Prescription management
• Laboratory review and interpretation
• Coordination with compounding and specialty pharmacies
• Secure messaging with your provider
  Priority scheduling access
• One hormone-related telehealth follow-up visit per month at no additional charge
• Vitamin B12 injections (up to 4 per month, if clinically appropriate and prescribed by your provider)
• Standard injection supplies for prescribed hormone therapies (syringes, needles, alcohol prep pads, as applicable) 

Please note: Injection supplies are provided only for medications prescribed through Bottumzup Health and Wellness, LLC.

MEDICATIONS, LABORATORY TESTING, AND PHARMACY FEES

Membership fees cover provider services and standard injection supplies only.

Membership fees do not include:

• Prescription medications
• Compounded medications
• Laboratory testing
• Shipping fees

Medication costs vary based on treatment plan, dosage requirements, and pharmacy pricing.

Membership fees are separate from medication costs and do not guarantee a prescription. All treatment recommendations and prescriptions are based on clinical appropriateness and provider judgment.

Required laboratory testing and follow-up appointments must be completed as recommended by the provider. Failure to do so may result in delayed medication refills or interruption of treatment.

Prescription and compounded medication fees are non-refundable once ordered or dispensed.

Prepaid memberships are non-refundable and non-transferable. Membership benefits remain active for the duration of the prepaid term.

PREPAY & SAVE OPTIONS- Please select one of the following options:

I understand that prepaid memberships are non-refundable and non-transferable. Membership benefits remain active for the duration of the selected membership term.

Please note: Weight Loss Program Member pricing is available only while actively enrolled in a qualifying weight loss program. If you complete or discontinue the Weight Loss Program, your membership rate may return to the standard membership rate. Discounts are applied at the discretion of the provider.

PATIENT ACKNOWLEDGMENT

I acknowledge that I have reviewed and understand the Hormone Optimization Program membership fees, included services, medication policies, laboratory requirements, refill policies, and prepayment terms. I understand that membership fees are separate from medication costs and do not guarantee a prescription.

 

Acknowledgment of Fee Disclosure

The Women's HRT Membership Fees, program benefits, medication policies, laboratory requirements, and applicable charges were reviewed with the patient. The patient was provided with the membership agreement and fee disclosure document, verbalized understanding of the information presented, and signed the acknowledgment form indicating acceptance of the terms.