Tampa Bay Holistic Wellness Disclosures and patient Policy
Welcome to Tampa Bay Holistic Wellness (“TBHW”). We are honored and delighted that you have chosen us as your functional medicine provider. We strive to provide treatments that blend the best of proven Traditional Chinese Medicine (“TCM”) practices alongside modern biomedical advancements. TBHW is committed to your successful treatment, and looks forward to partnering with you to address your health concerns.
TCM is a wonderful complement to Western medicine, but it is not a substitute for it. If we think you have a serious, undiagnosed medical condition, we will use our training and knowledge to determine whether there exists the need to refer you to your primary care physician. TBHW can provide complementary treatment for conditions that require a physician’s attention (such as your primary care physician); TBHW cannot provide alternative treatment for such conditions. At TBHW, your best interests are our interest, and we take our commitment to your care seriously. Likewise, we provide functional medicine services that many primary care physicians do not. Our specialty is lifestyle support through Traditional Chinese Medicine, acupuncture, herbal medicine, nutrition therapy, therapeutic exercise, manual therapy, adjunctive therapy and emotional release therapy.
TBHW practices Traditional Chinese Medicine (“TCM”), Acupuncture, Chinese Herbal Medicine and Oriental Medicine. Florida Statute §457.102(1) defines “Acupuncture” as “a form of primary health care, based on traditional Chinese medical concepts and modern oriental medical techniques, that employs acupuncture diagnosis and treatment, as well as adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease. Acupuncture shall include, but not be limited to, the insertion of acupuncture needles and the application of moxibustion to specific areas of the human body and the use of electroacupuncture, Qi Gong, oriental massage, herbal therapy, dietary guidelines, and other adjunctive therapies, as defined by board rule.” Fla. Stat. §457.102(1). TBHW strives to treat each patient as an individual. As such, TBHW will provide a unique course of diagnosis and treatment for each patient individually. TBHW practitioners will consider all TCM modalities, and may recommend one or more diagnostics and practices to each patient.
Notice of Privacy Practice: The law permits or requires us to use or disclose your Protected Health Information (“PHI”) for various reasons, which we explain in our Notice of Privacy Practice disclosure provided with our TBHW policy documents. When using or disclosing PHI or requesting your PHI from another source, we will make reasonable efforts to limit our use, disclosure, or request about your PHI to the minimum we need to accomplish our intended purpose.
Payment and Refunds: Patient shall provide payment to TBHW at the time of service, or upon the purchase of any nutritional supplementation or products (including packages and gift certificates). Fees and costs for service received by Patient and provided by TBHW will vary depending on Patient and the services being rendered to them by TBHW. TBHW may provide pricing on its website for certain services and products offered by TBHW, provided, however, that actual pricing may vary in accordance with the foregoing. All services and any nutritional supplementation or products (including packages and gift certificates) purchased from TBHW are non-refundable. Patient shall not receive any refund for the full or partial price of any unused service, nutritional supplementation, or product purchased from TBHW. Subject to the foregoing, if Patient pays in advance for any service or product, they acknowledge and agree that such service or product must be used within 365 days of the date of the payment in advance, after which time such service or product will be deemed to have been fully earned by TBHW.
Insurance: Patient acknowledges that TBHW is an “Out-of-Network” provider, meaning that TBHW is not a participant of any insurance network. TBHW is a private-pay practice. If Patient has Out-of-Network benefits that specifically cover services provided at TBHW, TBHW may, upon Patient’s request, provide Patient with a “super bill” for services rendered at TBHW in order to facilitate Patient’s streamlined submission of claims for such benefits, provided, however, that Patient does so at their sole risk and expense. TBHW shall not, and nothing in this Payment Policy Agreement obligates TBHW to, interact directly with any insurance company (including Patient’s insurance carrier or provider); nor does TBHW warrant or represent that any service provided to Patient by TBHW will be eligible for insurance benefits.
Forms of Payment Accepted: TBHW accepts the following forms of payment, subject to the terms and conditions stated herein: (1) cash; (2) credit and debit cards (including VISA, MASTERCARD, DISCOVER and AMEX); and (3) Health Savings Account (HSA) cards.
TBHW Cancellation Policy: As may be further described in TBHW’s Auto Pay Authorization Agreement or Payment Policy Agreement, scheduled appointments must be cancelled and acknowledged as cancelled by TBHW within 48-hours of such scheduled appointment. Any scheduled appointments not cancelled by the Patient within 48-hours of such scheduled appointment will be deemed a “Late Cancellation” and TBHW may charge Patient full price for such scheduled appointment as a Late Cancellation. Subject to the foregoing: (A) if Patient misses a scheduled appointment, TBHW may charge Patient full price for such scheduled appointment as a Late Cancellation; and (B) if Patient is more than 15-minutes late to a scheduled appointment, TBHW may charge Patient full price for such scheduled appointment as a Late Cancellation and give the remainder of Patient’s time slot for such scheduled appointment to another patient.
NEW PATIENTS: Please complete your medical history and sign our TBHW policy documents prior to your scheduled appointment via your patient portal.
EXISTING PATIENTS: Please update any changes to your medical history prior to your scheduled appointment via your patient portal.
OFFICE APPOINTMENTS: If you are unable to complete your forms prior to your scheduled office appointment, please arrive at least 15-minutes early to complete at our office.
TELEMEDICINE APPOINTMENTS: If you are a new patient and unable to complete your forms prior to your scheduled telemedicine appointment, your appointment will be cancelled if your forms have not been completed 24-hours prior to your scheduled appointment.
TBHW Patient Portal: We have made it easy for new and existing patients to manage their relationship with TBHW! We are inviting you to Create an account with Tampa Bay Holistic Wellness. The benefits of creating an account include:
Easily viewing upcoming and past appointments
Booking appointments quickly
Managing your upcoming appointments: reschedule, cancel, or book a similar appointment
Securely filling in your new patient forms from the comfort of your home
