A few details before your first visit.

Medication Safety & Prescribing Policy

I understand medication recommendations are based on a comprehensive clinical evaluation. Certain medical conditions may limit or prevent the use of specific medications. Treatment decisions are based on physician judgment and safety; prescription is not guaranteed.

Telemedicine Consent

I understand telemedicine has limitations compared to in-person evaluation, that technical interruptions may occur, and that my physician may recommend in-person care when appropriate. I understand I should call 911 in the event of a medical emergency. I consent to receive care via telemedicine.

HIPAA Privacy Acknowledgment

I acknowledge I have been provided access to the Notice of Privacy Practices and understand how my medical information may be used for treatment, payment, and healthcare operations.

Financial Policy

Velora Medical Institute is a direct-pay practice. Payment is required prior to services; services are not billed to insurance. Medication, laboratory, and pharmacy costs are not included in visit fees.

Cancellation Policy

Appointments must be canceled or rescheduled at least 48 hours in advance. Initial consultation late cancellation: $95. Follow-up visit late cancellation or no-show: $75. Program cancellation incurs early termination fees as stated in the program agreement.

Medical Consent & Medication Risks

I understand treatment may include prescription medications and have reviewed the possible side effects and risks for both weight management medications and hormone therapy. I understand results vary, ongoing monitoring is required, and I will report side effects promptly. I consent to treatment.

Patient Attestation

I certify the information provided is accurate and complete. I understand incomplete or inaccurate information may affect my care.