Bio-Identical Hormone Replacement Treatment Plan

BIO-IDENTICAL HORMONE REPLACEMENT TREATMENT PLAN

Please complete and submit the Medical History form available here. Alternatively, forms can be obtained at our office or by mail upon request.

Office Consultations:

Initial Comprehensive Laboratory and Clinical
Assessment Consultation (80-120 minutes) individual fee $500

>Group Discount, 2 or more people – per person fee $400

Review of medical history, including present medications

Review of previous testing

Vitals/Exam/body composition determination

Extensive discussion of patient symptoms and concerns

Identify clinical issues

Review and discuss extensive laboratory testing/results (comprehensive test panel paid for by our office, there is additional charge for labs requested outside of the test panel performed) and correlate with specific to symptoms/concerns/goals

Design individualized therapy to reach desired goals

In office (via phone only after first consultation)

Provide extensive written review of laboratory results with detailed explanations

Includes brief follow-up discussion if required ( 5 minutes) and easy access to office staff(who review questions with physician) for questions regarding therapy. medications , or concerns

Will provide bill and codes to be submitted by patient for insurance reimbursement for the consultation

Bi-Annual Comprehensive Laboratory and
Clinical Assessment Consultation (80-120 minutes) $500

>Group Discount, 2 or more people – per person fee $400

(1 month prior to appointment) Design labs specific to treatment plan (comprehensive test panel paid for by our office)

In office (via phone if extenuating circumstances)

Review of previous and present lab results

Review and adjustment of individualized therapy

Vitals/Exam/body composition determinations

Extensive discussion with regard to patient symptoms and concerns

Delivery of written lab review by Dr. Carlson, with detailed explanations

Will provide bill and codes to be submitted by patient for insurance reimbursement for the consultation

Interval 3 Month Non-Laboratory Follow-Up $250

>Group Discount, 2 or more people – per person fee $200

In office (via phone if extenuating circumstances)

Review of lab results, and any new laboratory assessments

Review and adjustment of individualized therapy

Vitals/Exam/Body Composition determination

Extensive discussion with regard to patient symptoms and concerns

Will provide bill and codes to be submitted by patient for insurance reimbursement for the consultation

Additional Consultation -60 minute Consultation $250

(1 month prior to appointment) Design labs specific to treatment plan (comprehensive test panel paid for by our office)

In office (via phone if extenuating circumstances)

Review of lab results

Review and adjustment of individualized therapy

Vitals/Exam

Extensive discussion with regard to patient symptoms and concerns

Delivery of written lab review by Dr. Carlson with detailed explanations

Patients can schedule additional 60-minute consultations as needed.

3 months after the initial consultation a 60-minute follow-up is required
to fine-tune treatment.

30 minute Consultation $175

Patients can schedule additional 30-minute consultations as needed.

Prescriptions

Prescriptions for medications provided for a 3-month time period at the time of initial/bi-annual consultations. Patients must have bi-annual lab work/consultation and at least one consultation in person every 2 years for prescriptions to be filled. Very few insurances companies will reimburse for compound pharmacy medications, but a portion of the consultation is often reimbursed by the insurance company. We will be happy to send your prescriptions to any pharmacy you request, however please understand there may be variability in some of the compounding pharmacies, so we have based our choices on pharmacies that have provided excellent service to our patients over the years, reliable quality of product, and verified clinical and laboratory results in our patients.

Insurance

Dr. Carlson does not bill insurance; however Dr. Carlson will provide a statement that you

can submit to your insurance carrier..

Discontinuing Treatment

There is no contract requiring you remain with the practice for a set time duration ( ie one year contract). You may discontinue your treatment at any time. If you have already scheduled your next appointment, we ask that you cancel the appointment at least 24 hours in advance.

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Patient Signature (if you understand the prices and frequency of appointments required for treatment)