Step-by-Step

HOW TO SCHEDULE A HORMONE HEALTH EVALUATION

"Our consultative practice is designed to give you an integrated picture of your health — to show you how all the pieces of your “health puzzle” fit together."

1. Send in signed YELLOW administrative forms and ALL of the Self-questionnaires to help determine which services will be most beneficial for you. (If emailed, forms will be white.)
   
   
2. We must have the originals MAILED to us. Faxed copies are not legible. Please do not fax the yellow forms to us.
   
   
3. When we receive the forms and self-questionnaires, our office will contact you to arrange your appointments and lab options. You will be contacted in order of our receipt of the yellow pages. (If emailed, forms will be white.)
   
   
4. Because your appointment is serveral hours of time being held for you, the appointment fee for initial consults will be charged to your credit card at the time an appointment is made.
   
   
5. The lab fees will be charged to your credit card at the time the requisition is prepared and sent to you. The date the requisition is prepared and sent is considered “date of service” since this requisition is a cash voucher for you to use and all lab costs will then be billed to our account. If you later are unable to use the lab requisition, fees will be promptly refunded only AFTER you return the original lab requisition to our office.
   
   
6. The prices listed in this package are to be used as a guide. The prices charged will be those in effect when we receive your completed forms and are scheduled.
   
   
7. We will send you our second set of New Patient materials on WHITE paper (detailed medical history, registration form, additional questionnaires and directions to our office).
   
   
8. Fill out and PROMPTLY RETURN the ORIGINIALS of the WHITE forms (second package) AT LEAST TWO WEEKS prior to your appointment so that we can prepare your chart and Dr. Vliet can review them.
   
   
9. We will call you 1-2 weeks before your appointment if we have not received all of the new patient information or labs. This is to help insure that you have everything you need at your appointment, and to give you time to track down any missing items. Our goal is to help you have everything you need to make your appointment as helpful as possible.
   
   
10. Does insurance cover Elizabeth Lee Vliet, M.D.'s services? Most patients are reimbursed by their insurance plans a percentage of the fees depending on the plan and the terms of coverage for out-of-network coverage. We are not able to tell ahead of time what reimbursement is possible, since each plan varies. Each plan will require the diagnostic and service codes that can only be provided after the consulation. We do not file claims, but will give you the necessary forms and receipts with diagnoses and service codes to file your claim. We will also provide you a letter explaining the charges so you may file this with your plan.