I UNDERSTAND ALL APPOINTMENT REQUESTS CAN BE MADE AT AEFOSTERFNP.COM. 

I UNDERSTAND THIS CLINIC DOES NOT REFILL WEIGHT LOSS MEDICATIONS. 

I UNDERSTAND I MUST COMPLETE A FOLLOW-UP VISIT FOR ALL MEDICATION ORDERS UNLESS I HAVE A REFILL THAT WAS ADDED DURING A PRIOR VISIT.

I UNDERSTAND THIS CLINIC DOES NOT ACCEPT INSURANCE, BUT DOES WELCOME USE FOR PRESCRIPTION DRUG COVERAGE.

I UNDERSTAND I MUST REPORT ANY ADVERSE REACTIONS TO THE PROVIDER.

I understand that I cannot hold AE Foster FNP liable  for any health issue that I currently have or may have while she is treating me.

I understand AE Foster FNP cannot bill my insurance for any services  rendered and I will pay cash for these services.

I understand that no service will be provided  to me for free and all services will be scheduled.

I give my consent for AE Foster FNP to use  my health insurance to complete prior authorizations on my behalf to provide coverage for  drugs requested if applicable.

I understand that my insurance may or may not cover medications, but I will have the option to have a compounded or generic version prescribed at a lower cost than brand name.

I understand that I must  schedule a time to speak with AE Foster FNP for concerns regarding my treatment.

I understand that my information will be protected by HIPAA with AE Foster FNP.