MembershipGuyer Wellness Group Membership Program Guyer Wellness Group Membership Program This program is a 12-month plan that gives me access to my primary, anti-aging, functional medicine, and clinical wellness care plus rolls in all of my deductibles and co-pays for only $297 a month if you have insurance. If you do not have insurance, cash pay would be $397 a month. As a member, I understand that I receive VIP access to care, testing, treatment, and services. I will read this document in full as it outlines the exact details of this program and what is included. As I read each section, should I have any questions, I know to ask a team member so that I can have all of the information necessary to make an informed decision to become a member of this practice.Why should I choose Guyer Wellness Group Membership over a regular doctor’s office? Today 86% of disease is chronic and lifestyle driven. Understanding this, we take a different approach than most, ensuring that YOU, are at the center of care. Unlike other doctors, our team of certified physicians, nurses and coaches are also trained in functional and integrative medicine. This means we are trained in how to use nutrition, life style change, and cutting-edge testing to help you not only reverse and prevent disease but also thrive in today’s fast paced world.What is the Guyer Wellness Group 12 Month Membership? It is our answer to affordable care. We believe that every patient should have access to their doctor. With high deductibles, co-pays and limited coverage, the patient is the one that suffers. As a member of our concierge practice, you will have peace of mind knowing your exact out of pocket expense of only $297 with insurance each month/$397 cash pay with unlimited access to the care you need in our practice.We take a team approach and our members see more than just one provider during their health journey with us! Membership offers patients with unprecedented access to our providers, and the best integrative primary care available. Plus, all members are guaranteed time with their providers. This personalized approach ensures that we understand your health goals and work together.Is this covered by my HSA or FSA? You can use FSA/HSA for your membership. Each plan is different so you will need to contact yours to find out the exact approval process needed to cover your care.How am I billed? You will be set up on an automatic debit program. This ensures that each month, on the same day, your credit, debit or HSA card will be charged for the $297 insurance/$350 cash pay amount. This recurring charge is for 12 months. At the end of 12 months, you will have the opportunity to cancel with no cancellation fees or automatically renew staying locked in at the $297/397 rate even when rates for new patients go up.What if my card is updated, lost or stolen? We understand that cards expire, new cards get issued and accounts change. If this happens with the payment type you have with us on file, to avoid a 15% administrative processing fee for late payments, we request that you immediately notify us with your updated payment type so we can help to keep your membership and account active and in good standing. InitialWhat’s included in my membership? 1 Annual Comprehensive appointment with one of our providers, 30 minutes, billed to insurance but no cost to the patient. If patient does not have insurance, the $397 fee will cover your expenses. Fee includes all deductibles, copays, and care for one price. Normal follow up fees remain but at a membership cost of $150 instead of $175. No fee on Injections (Savings: $720) 10% discount on pellet treatments ($90-$300 annual savings) 1 Free B12 Injection weekly (Savings: $1,440) 1 Free Myer’s Cocktail IV, once monthly (Savings: $1,188) Advance notice of new treatments and therapies *Phone access to a staff member for after hours servicesWhen does my membership start? Membership begins the day you register in office. The following are not included in your membership fee: Supplements members choose to purchase through our platform or other sources Hormones or prescriptions advised by my Guyer Wellness Group Medical team The cost of laboratory tests (If you require testing, we offer affordable lab solutions) Healthcare services other than those specified above, whether provided by our group or others. Services provided other than by Guyer Wellness Group, such as emergency and specialized care, will be billed to you or your insurance plan by those providers. Non-medical services recommended by our group but provided by others, such as acupuncture and personal training.Scheduling and Cancellation of Appointments: We ask for your full respect to your time and the time of our team so that you can gain the optimal support you deserve. To ensure this, we have a firm cancellation policy requesting a 48-hour cancellation notice for all appointments with GWG providers. Canceling within less than 24-hours will result in a $100 charge to the credit card on file. Initial: No-shows: If you do not show up to an in office or video/ telemedicine appointment without notifying the specific person you have an appointment with either via email or by changing the appointment with the office, you will be charged $75 to the card on file.InitialWe are not an insurance plan: We advise all members to maintain a separate health insurance plan of their choosing. You should also note that the Affordable Care Act includes a general requirement that all U.S.citizens purchase health insurance. Our membership does not meet this requirement. We Bill Insurance:Due to our guarantee of time with our patients, this is considered added value services many of which insurance does not cover. We will however, bill your insurance on your behalf for the care that is covered. All billed services allowed will apply towards your deductible at no additional fee to you. We are not an emergency or urgent care: Our availability is during normal working hours Monday-Friday and your availability to reach us or access our services at any given time may be limited. If you require urgent care you should immediately call 911 or contact an emergency care services are not covered by your Guyer Wellness Group membership.Lab Testing: Some blood tests we offer as part of our functional medicine testing program may be covered by insurance and in these cases, we will work with you to access these tests through your insured provider. If additional advanced diagnostic testing is needed, the specific tests ordered will be personalized to you based on your initial evaluation with our team and may include blood, saliva, urine, food or stool testing. We will make every effort to make you fully aware of any additional lab fees that may be incurred and to give you the opportunity to choose which lab tests you feel comfortable paying for. You are under no obligation to purchase any specialty testing. At home test kits: If a lab test kit is mailed to you by Guyer Wellness Group you will be charged the day the kit is mailed. This is not included in your membership fee. Please note, if you have insurance, certain tests are covered and will be billed to your insurance saving you any out of pocket expense.We are not specialists: If you need to see a surgeon, OB GYN, or a cardiologist, for example, you will be referred appropriately. The costs associated with the services provided by specialists or any other health care provider outside of Guyer Wellness Group are not covered by your membership. Your membership may not be shared, assigned or transferred to anyone else even if you are not using it. We do offer employers the opportunity to provide our services to their employees on a discounted group basis. For more information on this, please contact us.Temporary interruption sin the availability of or access to Guyer Wellness Group services or interruptions due to circumstances outside of our control will not create a right to cancel your membership nor request are fund/credit. *** Lack knowledge that the terms and conditions of the Guyer Wellness Group Membership Program have been reviewed with me and I understand and agree to all terms. PrintnameDate MM slash DD slash YYYY SignatureDate MM slash DD slash YYYY I authorized the monthly use of my creditcard/HSA/FSASignatureCard NumberExpiration Date MM slash DD slash YYYY CIDBilling Zip CodeCommentsThis field is for validation purposes and should be left unchanged.