Privacy Policy & HIPAA Compliance

I hereby give my consent for New You Weight Loss & Wellness Inc. I understand that, as with all healthcare treatments, results are not guaranteed and there is no promise to cure. I have had the opportunity to discuss with my provider the nature and purpose of treatments and procedures.

I will immediately inform the provider if I experience any gastrointestinal upset, allergic reactions, or any unanticipated or unpleasant effects associated with treatment or supplements prescribed/recommended.

I understand that if an emergency medical condition arises, I am expected to call 9-1-1. I understand that if I have suicidal ideation or self-harm I will seek emergency services and/or call 9-1-1.

New You Weight Loss & Wellness Inc may recommend blood, saliva, stool, urine, or skin testing within their scope of practice. I agree to the use of such tests and will always have the opportunity to discuss their applicability and limitations with my provider prior to sample collection. I agree to pay the laboratory any fees due for sample collection and processing.

I consent to voluntarily engaging in a telemedicine consultation with New You Weight Loss & Wellness Inc. I understand that the video conferencing technology will not be the same as a direct patient/healthcare provider visit. Telehealth consultation has potential benefits including easier access to care, decreasing costs, and allowing visits from the comfort of my home. It also has potential risks including interruptions, unauthorized access, and technical difficulties.

Telemedicine services offered through New You Weight Loss & Wellness Inc are not an Emergency Service. In the event of an emergency or urgent medical issue, I will call 911, go to the emergency department, or go to an urgent care.

New You Weight Loss & Wellness Inc may, on rare occasion, allow telephone consultations — verbal conversation only, no video. I understand that these consultations have considerable limitations, including no physical exam or visual assessment. I consent to receive instructions via phone/telemedicine platform and take full responsibility to follow through with specific instructions as required for my treatment.

The preferred method of communication is via HIPAA-compliant Patient Portal. However, New You Weight Loss & Wellness Inc provides patients with the opportunity to communicate by email. Transmitting confidential health information by email has a number of risks including unintended recipients and forwarding without permission.

All emails to or from patients concerning diagnosis or treatment will be part of the patient's protected personal health information. Email must never be used in a medical emergency. Email should not be used for communications concerning diagnosis or treatment of sexually transmittable or communicable diseases, behavioral health, mental health, or alcohol and drug abuse.

New You Weight Loss & Wellness Inc may use your name, address, phone number, and clinical records to contact you with appointment reminders, information about treatment alternatives, or other health-related information. By signing this form, you authorize New You Weight Loss & Wellness Center Inc to contact you with these reminders and to leave a message on your answering machine or with individuals at your home or place of employment.

You may restrict the individuals or organizations to which your health care information is released, or revoke your authorization at any time in writing mailed to the office address. This authorization will expire seven years after the date on which you last receive services from New You Weight Loss & Wellness Inc.

You authorize use or disclosure of your health information as described above. You understand photographs may be taken during treatment to document progress and may be used for marketing purposes — direct consent will be obtained and you have final editing rights to your images if selected for use.

New You Weight Loss & Wellness Inc does not file for insurance reimbursement. All services are paid by the patient at the time of service. You may pay cash, credit card, HSA card, or Flexible Spending Card. We will provide you with a superbill with all necessary codes so that you may file for reimbursement with your insurance company.

All outstanding balances must be paid in full prior to your next office visit or receiving supplements.

This office requires 48-hour notice if you are unable to keep your appointment. If you miss an appointment or fail to give sufficient notice, you will be charged $50.00 for that missed appointment. This payment is expected before any further treatment will be rendered or supplements can be purchased.

There is a $30.00 fee for any check returned by the bank.

If your account becomes past due over 90 days, the credit card on file will be charged. If the credit card declines, your account will be referred to our collection agency. If we have to refer collection to a lawyer, you agree to pay all lawyer's fees plus all court costs.

Completing special insurance forms, workplace documentation, writing letters of medical necessity, ESA, etc. require significant provider time and will be charged an administrative fee of $50 per document/letter. Fees must be paid in advance.

Many supplements, vitamins, medical grade foods, nutritional powders, botanicals, and homeopathic remedies have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease.

NO REFUNDS, CREDITS, OR EXCHANGES are allowed on any supplements, herbs, homeopathic remedies, vitamins, or nutritional supplements. All sales are FINAL.

You authorize New You Weight Loss & Wellness Inc to maintain your credit card number in the electronic health record and to use it to process payment for services rendered or supplements purchased. You authorize processing the card on file for any balance due past 90 days and for any payments authorized by you.

Treatment: We may use and disclose your PHI to provide you treatment, including disclosing it to other medical providers, trainees, therapists, medical staff, and office staff involved in your healthcare.

Payment: Your PHI may be used to facilitate payment or reimbursement from an insurance company or another third party.

Healthcare Operations: We may use or disclose your PHI to operate this medical practice, including training, quality improvement, and contacting you by telephone, email, or text to remind you of appointments.

Research: We will not use or disclose your health information for research purposes unless you give us authorization to do so.

Required by Law: We will disclose PHI about you when required to do so by federal, state, and/or local law.

Public Health Risks: We may disclose your PHI, if necessary, to prevent or control disease, report adverse events, or prevent injury, disability, or death.

Lawsuits: We may disclose your PHI in response to a court action, administrative action, or a subpoena.

Access to medical records: You have the right to access and receive copies of your PHI. Submit a written request to the contact listed below. We reserve the right to charge a fee for the time to obtain and copy the information.

Amendment: If you believe your PHI is incorrect or incomplete, you may ask us to amend it with a written request explaining why.

Accounting of Disclosures: You have the right to receive a list of instances in which we disclosed your PHI. Submit a written request to the contact below. This information may not go back more than 3 years.

Restriction Requests: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations.

Confidential Communication: You have the right to request that we communicate with you about healthcare matters in a certain way and at a certain location.

Complaints: If you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services.