New Patient Policies & Consent

COMPLETION OF FORMS: Request by patients to have forms completed should be made in advance. If you need a form completed, please furnish us with a copy of the form prior to your visit. Some lengthy forms will require a separate office visit to complete the required examination. If such a visit is required, regular office visit charges/copayments will apply. Please be advised that we cannot always complete these forms – some require the services of a specially certified person.

PAPERWORK POLICY: A fee of $25 is required for all paperwork requests and must be paid at the time of pick-up or before the paperwork is mailed or faxed. Requests are processed in order they are received. Please allow approximately one week for processing and be mindful of others who submitted requests before yours. The fee may vary based on the length and complexity of the paperwork, as determined by the provider.

Fee: $25

FMLA
Disability Forms
Home Health Forms
Parking Affidavit/Handicap Form
Adoption Forms
Sport Physical Education Forms
Nursing Home Entrance
Assisted Living Forms
Jury Exemptions
Miscellaneous letters

Medical record requests are priced individually. Please call our Medical Records Department to determine your cost.

Please note:

Charges are not billable to your insurance provider and are your responsibility.
All fees must be paid before your next appointment."

Medication Refills

Please call your pharmacy directly to check on the status of the medication refill and plan accordingly.

Calls after 12 noon on Fridays or the day before a holiday may not be addressed until the next business day.

To request a prescription refill, please call the number below or FAX your request.

Phone: (478) 302 0326 ext 101

FAX: (478) 202 3350

Please make sure that you provide the following information:

Patient's name and date of birth
Caller's name (if different) and phone number
Drug name, dosage and how it is taken
The pharmacy name

CANCELLATION POLICY: I understand that if I am unable to attend my appointment, I must notify Primal Medical and Wellness at least 24 hours in advance. Failure to do so will result in a $35 no-show fee, which is not covered by health insurance. Additionally, if I arrive more than 15 minutes late, my appointment will be rescheduled.

ARRIVAL TIME FOR ALL PATIENTS: All patients should arrive 30 minutes prior to their first scheduled appointment time and 15 min in the subsequent ones. All patients who arrive more than 15 minutes passed the scheduled time will be considered a no-show and will require to pay a $35 no-show fee that must be paid prior to the next scheduled appointment.

NO-SHOW POLICY: I understand that it is my responsibility to keep track of my appointments, and Primal Medical and Wellness may or may not provide courtesy reminders. If I miss a new patient appointment, I acknowledge that I will not be rescheduled for the same day. Missed appointments will incur a $35 no-show fee, which is not covered by health insurance and must be paid in full before scheduling the next appointment. I understand that accumulating two no-shows may result in my dismissal from the practice.

DISMISSAL POLICY: At Primal Medical and Wellness, our providers are committed to a collaborative approach in managing and treating your health. We view the physician-patient relationship as a partnership built on mutual respect, trust, and shared responsibility. However, certain situations may necessitate the termination of this relationship.

These situations include, but are not limited to: Treatment Non-Adherence:

The patient consistently refuses to follow the recommended treatment plan.

Follow-Up Non-Adherence: The patient repeatedly cancels or fails to attend follow-up appointments.

Verbal or Physical Abuse: The patient or a family member engages in inappropriate behavior, including the use of disrespectful, offensive, or threatening language, engaging in violent actions, or acting in a manner that compromises the safety and wellbeing of office personnel.

Dishonesty: Any behavior that undermines trust or the integrity of the physician-patient relationship.

Poor Rapport: The relationship between the patient and the provider has deteriorated to the point where effective care is no longer possible.

Non-Payment: The patient has an outstanding balance and declines to work with the office to establish a payment plan.

At PRIMAL MEDICAL AND WELLNESS LLC, we strive to provide clear guidelines on billing and financial responsibilities.

For insured patients, our practice files claims directly with your insurance provider. It is essential to provide accurate and updated insurance information. If your insurance changes, you must notify us promptly; otherwise, you will be responsible for the full balance.

Patients are responsible for all co-payments, deductibles, co-insurance, and cost-sharing amounts as determined by their insurance plans. Co-payments must be paid in full before services are rendered, and a $5 billing fee will be applied if a copayment is billed instead of paid at the time of service. Payments for balances not covered by insurance is required upon receipt of a billing statement. An unpaid balance can be negotiated, and failure to honor the agreement will result in dismissal from the practice.

Patients are responsible for full payment of all cash-based wellness services, including but not limited to B12 injections, IV fluids, and other vitamin or hydration therapies. These services are not covered by insurance and must be paid in full at the time of service. By proceeding with these services, you acknowledge and accept financial responsibility, regardless of any insurance coverage you may have.

For non-insured patients, full payment is required before services are rendered, with no exceptions. Any procedure or lab charges will be explained in advance and must also be paid before receiving services.

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