Sanctuary Functional Medicine DBA, LLC
120 Holiday Court, Suite 2
Franklin, TN  37067

 

POLICY INFORMATION: FOUNDATIONS PROGRAM ONLY

 

Sanctuary requires regular visits to remain an active patient.
You agree that to maintain services of Sanctuary Functional Medicine, you will need to be seen in person a minimum of every 12 months if only on supplements. Patients obtaining ongoing prescription medication with refills through our providers, will need to be seen at least by a telemedical visit at a minimum every 6 months. You understand that ongoing controlled prescriptions and psychiatric medication prescriptions require an in-person visit every 6 months and enrollment in an ELP monthly program.

Sanctuary does not provide urgent care medicine in-office.
You understand that Sanctuary and its providers are not providers of urgent care medicine.  For example, we do not perform laceration suturing, manage acute life-threatening infections, manage fractures, nor manage severe heart or lung conditions.  This list serves as an example but is not exhaustive of the urgent services we are not equipped to handle in the office.

The costs of lab tests are not included in the treatment program and therefore an additional cost.
Please note there are labs that are paid at the time of service, as well as lab testing that will be billed to you through Sanctuary Functional Medicine and/or the individual lab company.  Those tests billed to you through Sanctuary require payment of half down at the time of the lab draw and full payment within 30 days of billing. Please note this program has limited lab testing. Discounted prices are offered only to full treatment program patients or monthly patients.  Once patient ends care with office, these prices are no longer available.

Follow-up visit after initial consult.
Your first follow up visit may vary from 3 weeks to 6 months.  This follow-up requires either a 30 or a 45 minute visit to review labs and cover any therapy monitoring.  Timing and length of this visit with the Nurse Practitioner and Dr Potter (if 45 minute visit) will be recommended based on your personal diagnosis, situation, and plan. After that visit, any additional visits may vary from 15 minutes to 45 minutes based on needs and preferences.  If you do not complete this follow up visit within 6 months of initial visit, this contract is not renewed.  Lab results will be released but for a therapy plan, this second visit is required.

Options after first follow up visit.
Patients have the option of continuing Foundations Program pay per visit, transitioning to Intensive/Comprehensive Program, or enrolling in the Empowered Life Program.

1)  Pay Per Visit:  THIS IS THE DEFAULT OPTION IF OTHER OPTION IS NOT CHOSEN

• 25-30-minute visits with Dr Potter are $280
• 25-30-minute visits with the Nurse Practitioner are $230
• Visits longer than 30 minutes will charged according to time.
• Includes 15 % discount for supplements ordered through Fullscript
• Portal access to receive messages, but no portal access to send messages.

This means No secure 2-way portal messaging is provided although you can receive message, view lab results, and address invoices.

• Patient must have appointment every six months to receive refills on prescriptions. If patients do not have prescriptions through Sanctuary providers, then appointments are required every 12 months
• Access to providers is limited to the hours of 7am to 6pm, Monday through Friday.
• Urgent or emergent calls outside of these hours will incur a minimum charge of $100 and be referred to the necessary treating facility.
  • Care requiring 10-19 minutes will be $150, 20 to 30 minutes will be $300.
  • Requests for care after 6pm constitute agreement to these charges.
• Please note, this Pay Per Visit option is not available if the patient has a prescription that is considered a controlled substance.

2)  Empowered Life Program

• Monthly subscription of $110 per month,
• With the Foundations Program, you can elect to enroll in the Empowered Life Program (ELP) any time after the first visit. The first included 6-month visit will be scheduled from the date you sign up for the ELP and this visit cannot be moved up.  You can schedule additional visits between the 6-month check-ups for a discounted rate.
• Those enrolling in the ELP subscription directly after the first visit will still need to complete the 45-minute second visit from the Foundations Program but the rate will be discounted to $230 rather than $345.

3) Future Option to Convert to Comprehensive Program

• Within 6 months of initial 1 hour visit with clinical staff, you have the option to convert to the Comprehensive Program and have your $495 credited to the Full Price of the Comprehensive Program.
• When you convert to the Comprehensive, you will NOT have the 90 minute Introductory Visit. Instead you will have another 45 minute visit scheduled with your dedicated nurse practitioner followed by 15 minutes with Dr. Potter to discuss further testing plan.

Cancellations and “no shows”:
Because of the financial impact cancellations and missed appointments have on the consultant, there will be a fee for appointments not kept without a 72-hour notice.

Should you reschedule the 60-minute visit with less than 72 hours prior to start of that visit, there will be a $200 rescheduling fee.  Note: Monday and Tuesday appointments require notice by same appt. time on preceding Friday.

For re-scheduling follow-ups (this does not refer to 60-minute appointment) the fee is $150.   The required notice is 48 hours with Monday appointments requiring a Friday notice by Noon.

Lab draw appointments require a 24 hour notice to reschedule.  Monday appointments require notice no later than NOON on Friday.  Late notice of cancellation will be charged $25.

Refunds:
For Foundations Program, after visit is complete, there are no refunds for these single visits.
Lab costs performed through our office billing will not be refunded.

Dismissals from the practice:
If you are dismissed from our practice for any of the below noted reasons, you will receive a refund according to the Refund policy noted above.

Reasons include but are not limited to:  1) Inappropriate behavior or language directed at any Sanctuary staff.  2)  Any threats against clinic or staff.  3)  Failure to pay balance over $100 for period of 6 months unless payment plan approved.

In the event of dismissal, you will receive a letter notifying you that you have 30 days to locate another physician.  Emergency care only will be provided by our staff during those 30 days.  We will transfer records to the new physician by fax or to you by the portal upon receipt of a release of information form.

Late Payment.
 Please notify us of credit card or debit card changes promptly. It is ultimately patient responsibility to update any card change information prior to the monthly fee being charged. A $20 fee will be charged for payments that are late beyond 15 days of the due date (i.e. normally paid on 15^th would mean we would expect an update before the 30^th

Patient communication via portal, email, or phone.
The patient portal is used to upload documents, forms, test results, etc. as well as to making simple inquiries on an order. If you have any questions that require clarification or a prolonged answer from Dr. Potter or clinic staff, please call to schedule a time via phone to discuss.

Communication directly to the email address provided by you to Sanctuary Functional Medicine may be occasionally used to notify you of upcoming events, general practice announcements, as well as to send you newsletters and blogs. If you do not want to receive this type of communications, you can opt out of those via the email unsubscribe reporting notice.

 

 

Last Update 8/3/2021