To the Patient:
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The initial consultation fee is $125 (includes a 45 minute consultation, an insurance receipt, a formal recommendation to your prescriber and a 6 week follow-up telephone visit). Your medical information is confidential and will be handled according to our privacy policy (attached).
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Please sign and return one copy of the Consultation Agreement verifying receipt of this information.
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The BHRT evaluation form is to be completed prior to your initial consultation appointment. When scheduling an initial consultation, a deposit of $20.00 may be required using a credit card, which will be deducted from your initial consultation fee. Cancellations may be made 24 hours in advance to avoid charges.
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After the consultation, a report will be prepared by the Consultant Pharmacist and faxed to your prescriber. This report will be a summary of your information with dosing recommendations that must be APPROVED and prescribed by your physician. Once we receive authorization from your physician, your therapy will be prepared.
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You will be contacted when the medications are ready to be picked up or mailed to you. The
Consultant Pharmacist will provide you with a brief consultation to explain dosing and device operation. This consultation is included in the fee and takes about 10 minutes. The Pharmacist will also explain and review the Plan of Care.
 A medication universal claim form will be provided with your medication if you choose to bill your insurance. You will receive an insurance receipt if you would like to try and bill your insurance for the initial consultation.
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When you pick-up or have your medication mailed to you, a 6 week telephone visit will be scheduled with the pharmacist to assess your response to therapy. During this follow-up visit, the pharmacist will refer to the initial symptom sheet you completed as part of your consultation form. Your responses will enable the Pharmacist to recommend dosage adjustments to your physician.

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If changes should become necessary, keep in mind your physician must approve changes. This may take 3 to 4 days. If a refill is due and the review is not complete by the physician, changes will not be processed until the next refill. Do not stop the medication or adjust the dose unless directed to do so.
 Three business days must be allowed for refills. Your medication is uniquely compounded for your symptoms. Physicians require 48 to 72 hours for refill approval. Also keep in mind shipping time.
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Follow-up telephone appointments will be scheduled at the preceding appointment and will be about
15 minutes. Consultation fees will be determined based on time spent reviewing the case and may range from $30.00 to $50.00.
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Calls to the pharmacy other than scheduled follow-up appointments will be responded to on Tuesdays and Thursdays in the order received. You may leave your questions on the Pharmacist’s voice mail. If the phone call requires more than 10 minutes, a charge for the telephone visit will be incurred and may range from $30 to $50 depending on the time required to review your case.
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If you continue to have symptoms or your symptoms reappear during treatment, do not assume the hormones are not working. Please examine and consider other variables in your life that may be affecting your hormones such as stress, job changes, increase workload, thyroid changes, family situations, holidays, diet changes and more… It will be extremely important to disclose any of these variables during follow-up appointments so the Pharmacist can make informed decisions knowing all the variables and you can achieve the optimal benefit from your hormone therapy.
 Initial or repeat saliva testing will be determined on an individual basis. Please stay up to date on annual mammograms and pap smears.
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Annual consultations will be required to continue therapy.
I have read this Consultation Agreement and understand that it is in my BEST interest that I adhere to the above mentioned guidelines to achieve optimal benefit from this therapy.
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Signature Date
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I look forward to working with you and helping you feel better. You deserve it!
Sincerely,