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

 

ADDITIONAL INFORMATION:
VISIT EXPLANATIONS, EXTRA VISITS, COMMUNICATION, CANCELLATIONS/MISSED APPT., LATE ARRIVALS, DISMISSALS, and LATE PAYMENTS

 

INTENSIVE PROGRAM

Introductory Consult Visit:
This first visit will be at least 90 minutes with the clinician team. At this time, your dedicated nurse practitioner will take a detailed history, complete a physical exam, review records or prior tests and then in conjunction with Dr. Potter provide a detailed plan which may include testing, nutritional recommendations, supplements, vitamins, or medication recommendations. The plan will be presented by Dr. Potter after review with the nurse practitioner.  Please allow 1 additional hour for the additional coordination of tests and case management. Therefore, the initial visit may require 2.5 hours.

Case Review Visits:
Follow-up visits will typically be recommended after an appropriate time (once initially planned testing has been completed). During these two approximately 45-minute visits, test results will be reviewed, and an intensive personalized plan will be presented and explained in 2 stages. These visits may be done in person or remotely (phone or video telemedicine).

Follow up visits (45 minute) included in Intensive Program:
Timing of these 45-minutes visits will be recommended based on your personal diagnosis, situation, and plan. These visits may be done in person via phone or in some instances telemedicine.

When additional visits or follow up visits are determined to be necessary or requested by the patient/patient family (beyond those included in treatment plan) or the patient does not extend their program beyond the initial plan those visits will be charged as follows:

• Fees for visits are based on time and practitioner. If you are scheduled for a 25-minute visit and it takes longer than 30 minutes for the appointment you will be charged accordingly. Visit fees are based on time spent, not on the time slot length of appointment.
• Visits with Dr. Potter are $140 per 15 additional minutes
• Visits with the nurse practitioner or physician assistant are $115 per additional 15 minutes

Communication and Coordination:
Between initial and last follow up visits, communications to clarify instructions, plan testing and follow-up are at no additional charge if the interactions are addressing the same concerns discussed at prior visits. If we have not discussed a health concern in a prior visit, we may ask you to schedule a flex visit or additional visit if flex visits have been completed.  If flex visits have been completed, additional visits will be at $280 per 25 minutes with Dr. Potter and $230 per 25 minutes with the physician assistant or nurse practitioner. This is rarely needed.

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. Please note, portal communication has a limit on the length of message you can send/write to us.

Communication directly to the email address provided by you to Sanctuary Functional Medicine may be used occasionally 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.

APPLICABLE TO ALL VISITS AND PROGRAMS

Cancellations and “Missed Appointments”:
We have a 72-hour Cancellation/Rescheduling Notice Policy for all Clinical Visits and a 24-hour Cancellation/Rescheduling Notice Policy for all Lab Draw Visits. We respect and excuse true emergencies. We respect and excuse true emergencies.

• Initial 90-minute visit: If missed without a 72-hour notice, a $500 rescheduling fee will be applied. Note: Monday and Tuesday appointments require notice by same appointment time on preceding Friday. Thursday appointments require a notice by preceding Monday at same appointment time.
• 45-minute visit: If missed without a 72-hour notice, a $300 rescheduling fee will be applied.  Note: Monday and Tuesday appointments require notice by same appointment time on preceding Friday.  Wednesday appointments require notice by preceding Monday at 9 a.m.
• 25-minute visit: If missed without a 72-hour notice, a $150 rescheduling fee will be applied. Note: Monday and Tuesday appointments require notice by same appointment time on preceding Friday. Wednesday appointments require notice by preceding Monday at 9 a.m.
• Lab Draw visit: If missed without a 24-hour cancellation/reschedule notice, a $25 fee will be applied. Note: Monday appointments require a notice by Friday at Noon.

Late for appointments:
In order to respect the following patients on the day’s schedule (emergencies excluded):

If you arrive 15 minutes late for a 30-minute appointment you will be asked to reschedule and pay a late cancellation fee or forfeit the visit if in a program.

If you arrive 15-22 minutes late for a 45-minute appointment, you can choose between receiving your remaining time or pay the rescheduling fee and reschedule. Arrivals after 23 minutes late will be asked to reschedule and pay a late cancellation fee or to forfeit the visit in a program.

If you are 15-25 minutes late for an Introductory Consult, you can receive your remaining time or pay the cancellation fee and reschedule.

If you are 25-40 minutes late, we will offer options based on the day’s schedule.

If you are over 40 minutes late, you will be asked to reschedule with a rescheduling fee.

Dismissals from the practice:
Dismissal from our practice is rare.  However, reasons for dismissal include but are not limited to the following:

• Inappropriate behavior or language directed at any Sanctuary staff.
• Any threats against clinic or staff.
• Failure to pay balance over $100 for period of 6 months unless payment plan approved.

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 in your contract.

If you are dismissed from the practice, 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. Any unpaid balances will be deducted from the refund.

Late Payments:
Please notify us of credit card or debit card changes promptly. It is the patient’s 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 15th would mean we would expect an update before the 30th).

Updated 8/3/2021 on file.