Schedule a Medical or Recovery Visit | THE ARMORY | Columbus, Ohio

  • Schedule a Medical or Recovery Visit

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  • Have you ever been seen by a medical provider at this practice?*
  • What is your membership status?*
  • What would you like to schedule today?*
  • Please select a provider from the list below*
  • Which type of IV hydration therapy would you like to schedule?*

  • Demographic Information

    Please provide your basic personal information. Accurate details help us maintain your medical record and ensure all communication and documentation are correct.
  • Format: (000) 000-0000.
  • Preferred Method of Contact*
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  • Gender*

  • Insurance Information

    Although THE ARMORY does not bill insurance for any services, we require your insurance information for our records. This information may be used when coordinating prescriptions, obtaining prior authorizations, or referring you to outside providers such as labs, imaging centers, or specialists.
  • Do you have health insurance?*
  • Please select your insurance provider. We do not bill insurance directly, but keep this on file to help coordinate your care.
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  • Pharmacy and Laboratory Information

    Please provide your preferred pharmacy and laboratory information. This allows our team to coordinate prescriptions, prior authorizations, and lab testing efficiently. If you haven’t had recent labs drawn, we’ll generate an order for you and contact you once results are available to schedule your provider visit.
  • Do have a preferred pharmacy?*
  • What is the name of your preferred pharmacy?
  • Do have a preferred lab for blood draws?*
  • What is the name of your preferred lab?

  • Current and Past Medical History

    Tell us about any current or past medical conditions, injuries, or surgeries. Sharing this helps us get a full picture of your health and provide the best care possible.
  • Are you healthy enough to exercise?*
  • Have you ever been diagnosed with any of the following medical conditions?*
  • Check all that apply
  • Are you currently injured?*
  • Have you had any relevant surgeries in the past?*
  • Are you currently taking any prescription or over-the-counter medications? *
  • Do you have any allergies we need to know about?*
  • Are you currently taking any athletic or performance supplements?*
  • Check all that apply
  • Are you currently taking or have you recently taken any illicit or performance-enhancing substances? Note: We’re here to help you, not judge you. Our team is extremely knowledgeable in this area, and our priority is to keep you safe and out of trouble.*
  • Check all that apply

  • Hormone Replacement Therapy

  • Are you currently on hormone replacement therapy?*
  • Do you have any biological children?*
  • Do you have any fertility concerns?*
  • Do you wish for children in the future?*
  • Please select any symptoms you’re currently experiencing. Check all that apply.
  • Please select any symptoms you’re currently experiencing. Check all that apply.
  • I currently feel as if I am....*
  • Are you current on your women’s health screenings, such as Pap smear and mammogram?*
  • Do you have a PERSONAL history of breast, uterine or ovarian cancer? Or history of other hormone receptor positive cancer?*
  • Do you have a known FAMILY history of breast, uterine or ovarian cancer?*

  • Hormone Replacement Therapy Laboratory Testing

    Before starting hormone replacement therapy, certain lab tests are required to ensure treatment is appropriate and safe. These include hormone levels and other key health markers that must be reviewed by your provider.

    If you’ve already had recent lab work completed elsewhere, please let us know and upload those results below so we can review them. If not, we’ll arrange to have your labs drawn before your first provider visit to make the process more efficient.

  • Have you recently had any lab work completed that you would like to share with us?*
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  • Acknowledgment

    If you have not uploaded recent or acceptable lab results, THE ARMORY will generate a lab order on your behalf. This order will be sent to you with instructions for completing your bloodwork at a nearby lab. Once your results are received, a provider from our practice will review them and contact you to schedule your appointment.

    After completing your labs, you’ll be expected to establish care with our practice to review and discuss your results. Please note that completing labs does not guarantee a prescription for hormone replacement therapy. The decision to prescribe will be based solely on your provider’s clinical judgment and whether treatment is deemed medically appropriate.

    While THE ARMORY does not accept insurance for services provided at our facilities (such as office visits or performance medicine testing), we require your insurance information for labs, external referrals, and prescriptions to help reduce out-of-pocket costs.

    Office visit fees typically range from $150 to $275. A Medical Membership option is also available for $195 per month, which includes unlimited medical visits, performance medicine testing, and access to all three fitness facilities.

     

  • GLP-1 Therapy

  • Have you ever used a GLP-1 medication before?*
  • Which GLP-1 medication did you try? (Check all that apply)*
  • Did you have any side effects or complications?*
  • Do you have a history of any of the following? (Check all that apply)*
  • What are your primary goals with GLP-1 therapy? (Check all that apply)*
  • How long have you been working toward these goals (through diet, exercise, etc.)?*
  • Have you had a DEXA scan or Resting Metabolic Rate (RMR) test at THE ARMORY before?*
  • Have you ever worked with a registered dietitian or nutrition coach?*
  • Have you ever worked with a personal trainer or fitness coach*
  • What is your average weekly physical activity level?*
  • Are you willing to complete baseline labs and follow-up testing (DEXA, RMR, etc.) as part of this program?*
  • Are you open to working with our dietitian or performance coach to support long-term results?*
  • Are you willing to commit to a regular exercise program?*
  • Do you understand that GLP-1 therapy is a medical tool meant to complement — not replace — lifestyle change?*

  • Exercise Physiology

  • Is this your first time seeing Breyona?*
  • What are your main goals for meeting with an Exercise Physiologist.*
  • What best describes your current exercise patterns? (Check all that apply.)*
  • What barriers make it difficult for you to exercise consistently?*
  • Have you had V02max testing in the past 3-6 months*

  • Dietitian/Nutrition Consult

  • Is this your first time seeing Samantha?*
  • Which type of nutrition visit best fits the your needs today?*
  • What are your main goals for meeting with the dietitian?*
  • Are you following any specific dietary restrictions?*
  • Are you currently experiencing any of the following gastrointestinal (GI) symptoms?*
  • Have you ever been diagnosed with any of the following gastrointestinal (GI) conditions?*
  • Have you completed a Resting Metabolic Rate (RMR) Test within the past 60 days?*

  • Physical Therapy

  • Is this your first time seeing Dr. Bishop?*
  • Have you previously had surgery on this area?*
  • Have you previously seen a Physical Therapist for this within the past 12 months?*
  • How did you hear about THE ARMORY?

  • New Client Intake Agreement – THE ARMORY
    Hayden Run Internal Medicine LLC, doing business as THE ARMORY

    This agreement consolidates the essential patient forms required for participation in medical care at THE ARMORY. By signing below, you acknowledge your understanding of and agreement with each section.


    1. Consent to Treat

    • I voluntarily consent to the medical care, treatment, and diagnostic procedures that may be performed by healthcare providers, their assistants, or designees at THE ARMORY.
    • This consent includes but is not limited to routine check-ups, diagnostic procedures, preventive care, and other services deemed medically appropriate.
    • I understand that the practice of medicine is not an exact science, and no guarantees or promises have been made regarding the results of my treatment or examinations.
    • I have the right to ask questions about my care, treatment, and services to make informed decisions. I also have the right to refuse any recommended medical procedure or treatment.
    • If I am signing on behalf of a minor, I confirm that I am the legal parent/guardian and have the authority to consent to their treatment. I remain responsible for all charges associated with the minor’s care.


    2. Notice of Privacy Practices (HIPAA)


    This notice describes how health information about you may be used and disclosed and how you can get access to this information. It has been effective since April 14, 2003 and applies to all protected health information contained in your health records maintained by THE ARMORY.

    Our Duties

    • We are required by law to maintain the privacy of the protected health information in your records and to provide you with this Notice of our legal duties and privacy practices with respect to that information.
    • We are required to abide by the terms of this Notice currently in effect.
    • We reserve the right to change the terms of this Notice at any time, making the new provisions effective for all health information and records that we have and continue to maintain. All changes in this Notice will be prominently displayed and available at our office.


    Uses and Disclosures Requiring Your Consent


    We may use or disclose your protected health information for treatment, payment, and healthcare operations once you have provided consent. These include:

    • Treatment: Decisions about provision, coordination, or management of your healthcare, including consultation with other providers.
    • Payment: Using or disclosing information to obtain reimbursement from you or another insurer, including eligibility, billing, and collections.
    • Healthcare Operations: Business planning and development, quality improvement, compliance activities, and administrative functions.


    We may also share your information with third-party business associates (e.g., billing or transcription services) under written agreements protecting your privacy.

    Uses and Disclosures Without Consent

    • Certain disclosures may occur without your consent, including:
    • Public health reporting (communicable diseases, HIV/AIDS, STDs)
    • Abuse, neglect, or domestic violence reports
    • Legal processes (court orders, subpoenas)
    • Law enforcement requests under applicable conditions
    • Coroner, funeral director, or organ donation purposes
    • National security, military, and intelligence activities
    • Worker’s compensation claims
    • Emergency treatment situations where consent cannot be obtained


    Your Rights

    • You may request restrictions on uses/disclosures of your health information. While not required to agree, if we do, we will comply except in emergencies.
    • You may request confidential communications via alternative methods or locations.
    • You have the right to inspect, copy, and request amendments to your health records (except psychotherapy notes or restricted legal documents). Reasonable fees may apply.
    • You may request an accounting of disclosures. The first accounting in a 12-month period is free; subsequent requests may incur a fee.
    • You may obtain a paper copy of this notice, even if you initially received it electronically.
    • You may file a written complaint with THE ARMORY or the U.S. Department of Health and Human Services if you believe your rights have been violated. You will not face retaliation for filing a complaint.


    3. Cancellation and No-Show Policy


    In order to provide the highest quality care and to maximize appointment availability, THE ARMORY requires at least 24 hours’ notice for cancellations or rescheduling of the following services:

    • Medical Services (including physician, nurse practitioner, physician assistant, and registered nurse visits)
    • Mental Health Services (including mental performance coaches, counselors, and psychiatric providers)
    • Physical Therapy
    • Nutrition and Dietetics
    • Exercise Physiology
    • Massage Therapy


    Cancellations or rescheduling received less than 24 hours in advance are subject to a $75 fee.

    No-shows, defined as missed appointments or cancellations made within two hours of the scheduled time, will result in a $75 fee billed to your account.

    Patients are encouraged to communicate promptly with Wellness Coordinators for scheduling assistance.


    4. Financial Responsibility and Cash-Pay Waiver


    I understand that THE ARMORY is a cash-based practice and does not accept or bill insurance for services rendered at the facility.

    I agree that:

    • Payment for all services is due in full at the time of service.
    • I am solely responsible for all charges incurred.
    • Any attempt to seek reimbursement from insurance is my responsibility, and THE ARMORY is not liable for insurer denials.
    • Charges may appear under Hayden Run Internal Medicine LLC, doing business as THE ARMORY on receipts or billing records.


    5. Medicare Patients

    If I am a Medicare beneficiary, I understand that THE ARMORY has opted out of Medicare.

    I acknowledge that services provided at THE ARMORY are not covered or reimbursed by Medicare. By signing this agreement, I enter into a private contract with THE ARMORY and agree to pay for services out-of-pocket.

    I understand that:

    • No claim will be submitted to Medicare for services provided.
    • I will not receive Medicare reimbursement for services at THE ARMORY.
    • I am fully responsible for payment at the time of service.


    6. Acknowledgment and Agreement


    By signing this agreement, I acknowledge that I have read, understand, and agree to the terms set forth in this Patient Intake Agreement.

    I understand that this agreement applies to all services rendered at THE ARMORY.

  • Do you acknowledge and agree to the terms of the waiver above?*
  • Is the patient 18 or older?*
  • Format: (000) 000-0000.
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