I acknowledge that Wired BioHealth™ has clearly explained the details of the services listed in this document and has also clarified that Wired BioHealth™ is not part of any insurance network for Functional Medicine consulting, testing, or treatment. The office and staff are not required to provide insurance statements, coding, billing statements, or documentation to seek insurance reimbursement. I understand that Wired BioHealth™ personnel act as consultants, not healthcare providers.
With my signature below, I consent to receive testing and Biochemical Pathway Support Plan recommendations, and acknowledge that all of my concerns and questions have been addressed by the Wired BioHealth™ staff. I understand that the objectives of this program are to help reduce my various chronic wellness complexities. I also understand that, given the chronic nature of my condition(s), a complete return to wellness is not guaranteed. I understand that the laboratories utilized by Wired BioHealth™ are CLIA-approved. Wired BioHealth™ is not responsible for the outcome of my health.
I understand that Wired BioHealth™ consultants do not oversee my healthcare. I understand that Wired BioHealth™ consultants do not write, modify, nor discontinue prescriptions written by my psychiatrist or healthcare provider. With my signature below, I attest that Wired BioHealth™ virtual visits and consultations do not involve nor replace medical care.
By signing this contract, I agree to the terms of service and fees of Wired BioHealth™. All testing and related fees will be paid in full prior to test kits being sent to the client. This contract does not include the cost of nutraceuticals, recommended future testing, or re-testing.
By signing this contract, I agree to provide 24 hours' advance notice if I need to reschedule or cancel any Review of Findings visit or Bi-Weekly Coaching Session. Failure to do so will result in a $75 charge for the missed visit. My decision to not utilize the Wired BioHealth™ test kits, discontinue use of Wired BioHealth's recommendations or virtual visits, and/or deviate from the Biochemical Pathway Support Plan recommendations will not result in a refund, either partial or full, and may result in termination of services upon discovery. By signing this contract, I understand that Wired BioHealth™ reserves the right to discontinue services at any time and for any reason, with notice.