Terms & Conditions

APPOINTMENTS AND CANCELLATIONS

The standard meeting time for the PCOS Sisters subscription visits or Single PCOS Evaluation Visit is 30 minutes.

Payment is required at time of booking appointment.

Cancelations and re-scheduled visits will be subject to a full charge if NOT RECEIVED AT LEAST 48 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for an appointment, you may lose some of the allotted time for that appointment. Your card will automatically be billed 24 hours prior to your appointment if payment is not received.

TELEPHONE ACCESSIBILITY

If you need to contact PCOS Sisters Telehealth Clinic & Wellness Center between sessions, please send us a message through the patient portal or give us a call. We are often not immediately available; however, we will attempt to return your call or message within 24 hours. Please note that Face-to-face video visits are required for a telehealth visit. If a true emergency situation arises, please call 911 or go to your local emergency room.

ELECTRONIC COMMUNICATION

We cannot ensure the confidentiality of any form of communication through electronic media, including, but not limited to, text messages, telephone communication, the Internet, facsimile machines, and e-mail. By providing an e-mail address and cell phone number on patient intake, you authorize us to communicate with you by e-mail or text message regarding Your “protected health information” (PHI). Patient further acknowledges that all such communications may become a part of the medical record. If you consent to the above means of communication by participating, you expressly waive the Provider’s obligation to guarantee confidentiality with respect to same.

Telehealth is broadly defined as the use of information technology to deliver medical services and information between two parties that are at different locations. The above electronic means of communication are considered telehealth. Utilizing telehealth services through PCOS Sisters Telehealth Clinic & Wellness Center is voluntary in nature and you need to understand:

1. You have the right withhold or withdraw your consent for telehealth services at any time. If this occurs, you need to understand that we cannot provide care for you any longer as PCOS Sisters Telehealth Clinic & Wellness Center is strictly a telehealth practice.
2. We will protect your protected health information in the same fashion as a brick and mortar practice. You need to understand though that data breaches can happen, and we cannot assure your information is 100% protected.
3. We will not use your protected health information for research purposes unless you give us consent to do so.
4. You must be physically located in the State that matches your providers license at the time of service for a telehealth visit to be performed. 
5. There are potential benefits, risks and subsequent consequences of telehealth. Potential benefits include, but are not limited to improved access to care, reducing costs, improving the quality of visits, and reduction of travel time associated with medical visits. The medical provider will make assessments, diagnoses, and treatment plans based off all the visual and auditory information provided during the video conference. You must understand that this is limited and posts potential risks including, but not limited to the provider’s inability to make complete diagnostic assessments that might require a physical exam and to see the patient in person. During an in-person encounter, a medical provider has the ability to see the entire patient including but not limited to their gait, smell, general appearance, and demeanor. Potential consequences thus include the provider not being aware of clinically significant information that you may not recognize as significant to present verbally to the provider.

It is at the provider’s discretion to obtain an in-person physical examination of the patient prior to initiating treatment. An inspection examination will be performed during the initial video visit. A physical exam can be done by a local primary care provider or at an urgent care and sent to PCOS Sisters Telehealth Clinic & Wellness Center.

MINORS

We require parental consent for all visits done through telehealth. We require your parents to be present during a portion of the visit to ensure that they are consenting to treatment.

If you are a minor, your parents may be legally entitled to some information about your treatment. We will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

SCOPE OF SERVICES

I understand that I am voluntarily engaging in a telehealth consultation with PCOS Sisters Telehealth Clinic & Wellness Center providers, which may include Autonomous Advanced Practice Registered Nurses defined by Florida Statute ss. 464.001-464.027 as an Advanced Practice Registered Nurse who practices independently without supervision of a physician, only engaging in primary care practice including family medicine, general pediatrics, and general internal medicine; Definition of primary care includes physical and mental health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions. Per Georgia and Texas state statutes, your Nurse Practitioner is supervised by Dr. Vivian Okirie, MD.

Your membership includes unlimited visits with your provider via telehealth, a personalized diet and exercise plan, and a PCOS evaluation visit.

I acknowledge that no controlled substances such as narcotic pain medications will be prescribed via telehealth visit per federal law requiring in-person visit.

I acknowledge that no medications termed “obesity medications” such as phentermine will be prescribed via telehealth visit per Florida law requiring in-person visit.

We do not bill health insurance or any other third parties for services included in the periodic fee.

This agreement is not health insurance and does not meet any individual health insurance mandate that may be required by law.

PROVIDER ABSENCE

From time to time, due to vacations, illness, conflicting obligations, or personal emergency, the provider may be temporarily unavailable to provide the services referred to above in this paragraph one. In order to assist patients in scheduling non-urgent visits, clinic will notify patients of any planned provider absences as soon as the dates are confirmed. In the event of the provider’s unplanned absences, Patients will be given the name and telephone number of an appropriate provider for the Patient to contact. Any treatment rendered by the substitute provider is not included under this Agreement.

AFTER HOURS ACCESS

Clinic will make all reasonable efforts to provide telephone and text access to the provider after hours for urgent needs. Patient shall be given a phone number where patient may reach the provider directly for guidance regarding concerns that arise unexpectedly after office hours.

ADDITIONAL FEES

Cost of labs and imaging are not included in membership subscriptions. However, you may use your own insurance to cover these costs. Patient will be invoiced by PCOS Sisters Telehealth Clinic & Wellness Center for cost of PCOS Sisters discounted labs, if not using insurance and qualify per state law. A $35 lab interpretation fee is included with these labs. Labs are non refundable after being sent. Any purchase, once processed, can not be refunded and charges moved from one card or bank account to another. 

*Per New York State Laws: New York patient subscription includes one monthly telehealth visit, all additional telehealth visits are $35 per visit. Discount labs not available. However, you may use your insurance to cover labs. 

INSURANCE POLICIES

Neither the Practice, nor its Provider, participate in any health insurance or HMO plans or panels.

This agreement is not an insurance plan or a substitute for health insurance. This agreement does not replace any existing or future health insurance or health plan coverage that you may carry. The Agreement does not include hospital services, or any services not personally provided by the PCOS Sisters Telehealth Clinic & Wellness Center or its staff. You acknowledge that we have advised you to obtain or keep in full force, health insurance that will cover you for and for hospitalizations, catastrophic events, and all other healthcare not personally provided by the PCOS Sisters Telehealth Clinic & Wellness Center.

Due to regulatory restrictions, services are not available to patients who are eligible for or enrolled in

Medicare, Medicaid, or other government healthcare programs. By signing below, you deny that you are currently enrolled in Medicare or Medicaid. You understand that if you should enroll in Medicare or Medicaid, we will no longer be able to provide you services. If Patient becomes a Medicare beneficiary Patient has a responsibility to inform Provider and PCOS Sisters Telehealth Clinic & Wellness Center of that change in status. Patient acknowledges and accepts this responsibility.

I acknowledge and understand that PCOS Sisters Telehealth Clinic & Wellness Center does not guarantee reimbursement for any PCOS Sisters Telehealth Clinic & Wellness Center service or fees from any third-party health plans, including insurance plans and savings accounts (health savings or flexible spending).

This agreement is not health insurance and the primary care provider will not file any claims against the patient’s health insurance policy or plan for reimbursement of any primary care services covered by the agreement. This agreement does not qualify as minimum essential coverage to satisfy the individual shared responsibility provision of the Patient Protection and Affordable Care Act, 26 U.S.C. s. 5000A. This agreement is not workers’ compensation insurance and does not replace an employer’s obligations under chapter 440. This is not a Health Maintenance Organization (HMO) defined by New York state law as an organization that provides comprehensive health service plans to maintain good health. An annual physical exam is necessary to maintain comprehensive health services. As a telehealth only practice, we do not provide this service.