Self-Pay Lab Services

Purpose of This Form:

You are choosing to access discounted lab testing through Bottumzup Health and Wellness using Fullscript and/or partner laboratories. This option is designed to lower your out-of-pocket costs compared to billing through insurance.

✅ How This Benefits You:
*Access to negotiated, lower-cost cash pricing on labs.
*No surprise bills from insurance or third-party billing.
*Faster turnaround and more control over what’s tested.
*Labs selected are based on clinical relevance to your care, not insurance limitations.

💳 Billing & Payment Structure (Updated):
You will now receive one combined invoice directly from Fullscript, which includes:

✅ The cost of the lab tests
✅ The clinical service fee for:

Ordering and coordinating labs
Interpreting results
Integrating labs into your care plan
Communicating next steps

Covers clinical services including:

Ordering & coordinating labs
Interpreting results
Integrating labs into your treatment plan
Communicating findings or adjustments

⚠️ Important Notes:
These labs are self-pay only and cannot be billed to insurance.
Your results will be sent directly to our office. We will contact you with your results and next steps once the lab work is reviewed.
Full payment (for both lab and clinical fee) is required before follow-up care or results discussion.

💵 Fee Structure (Clinical Service Fee):
This fee is now included in your Fullscript invoice at the time of lab ordering.

$60 for standard (non-membership) patients
$50 for patients enrolled in a practice membership or treatment package (ex: DPC, or HRT)

📌 Note:
The “Send invoice to patient” feature in Fullscript is available for non-recurring lab orders only.
Recurring lab plans may follow a different billing structure, which will be explained as needed.

Patient Acknowledgment – Self-Pay Lab Services

I understand that I am voluntarily choosing a self-pay lab option offered by Bottumzup Health and Wellness to access discounted lab pricing through Fullscript or its partner labs. I acknowledge that:

I will receive one combined invoice from Fullscript that includes both the cost of lab testing and the clinical service fee.
I am responsible for full payment before lab processing and result review.
These services are not billable to insurance.
The clinical service fee is:

$60 for standard (non-membership) patients (no program or membership)
$50 for patients enrolled in a membership program or treatment package (ex: DPC, or HRT)

I understand that I am responsible for the full payment of both the lab testing and the clinical service fee.

Prices are subject to change, Any changes will be communicated in advance.