Follow-Up Appointment Acknowledgment & Fee Consent Form Logo
  • Follow-Up Appointment Acknowledgment & Fee Consent Form

    Please review the information below and sign to acknowledge your understanding and agreement.
  • Weekly in-person follow-up visits are provided at no additional cost.

    However, a formal follow-up is recommended every 3 months for all patients.
    This visit includes a comprehensive review of your progress, lab work, and overall care plan. A $50 fee applies to these quarterly appointments.

    By signing below, you acknowledge and agree to the following:
    I understand that weekly in-person follow-ups are free of charge.
    I understand that a 3-month formal follow-up is recommended as part of my ongoing care plan.
    I agree to pay a $50 fee for each 3-month formal follow-up appointment.
    I understand that this fee is not optional and applies to all patients.
    I have had the opportunity to ask questions and understand this policy

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    Follow up  Product Image
    Follow up Recommended for all patients every 3 months. This appointment includes a comprehensive review of your progress, lab work, and care plan. Weekly follow-ups are free; this fee applies only to formal quarterly reviews.
    $50.00
      
    Total
    $0.00
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