**East Texas Functional Wellness, LLC (ETFW) SERVICES POLICIES** Our Mission is to assist you in achieving physical, spiritual, and emotional well-being using a holistic approach to health. Our Philosophy is to educate and empower you to live in optimal wellness.

** This approach complements any existing health care program.

**ETFW:** The intent of any and all services offered and/or nutritional protocols or lifestyle recommendations suggested by Dr. Austin, DC and the ETFW team is designed to support the natural physiological & biochemical processes of the human body. The purpose is not to diagnose, treat, prevent or cure any disease. All suggested protocols are from a holistic health perspective. As such, ETFW does not act as your primary care physician and you must continue to have a medical PCP and keep them informed of all your healthcare activities. Any questions? Contact the office at the Contact section of our website. Health Coaches may provide coaching and consulting regarding nutrition, supplementation recommendations, lifestyle changes, and health education but does not create a doctor-patient relationship. You must always have a Primary Care Physician that you work with in your hometown even if consulting with one of our practitioners. You agree to keep your doctor informed of all your health and lifestyle changes. Be especially mindful if you take prescriptions and lose weight as many prescribe based on weight.

**Consent to Participate in Telemedicine/Telehealth Consultation** By scheduling with ETFW and by signing this agreement I acknowledge that I am agreeing to participate in telemedicine/telehealth consultation (tele-consults) with the practitioners and/or staff at ETFW. I am seeking this tele-consult for my own purposes and not on behalf of any third party. I understand the risks, benefits, limitations and alternatives to tele-consults (including the option to seek a different practitioner for in-person services) and have chosen of my own free will to participate in tele-consults with ETFW. I understand I am a participant in the decision-making process and I am free to decline any service/treatment/recommendation/suggestion offered by the ETFW practitioners at any time. I accept that the ETFW practitioner may at any time refer me to a different office if the nature of my consultation is inappropriate for tele-consults. I understand that tele-consults typically involve the use of audio and/or video or other technology between me and the practitioner. Due to the nature of tele-consults, visits are largely educational and rely heavily on the patient history and laboratory findings. Exam and vital findings via video or phone are limited in nature vs an in-person examination.

**Cancellations:** We request a minimum of 24 hours advance notice for any cancellation or rescheduling of your appointment. This is a consideration to our practitioners. Short notice or no notice may result in an office visit charge at the regular rate.

**Payment of Services:** Payment in full is expected at the time of scheduling or at the time of service. ETFW receives payment in cash, check, electronic payments (venmo, paypal, etc.) credit and debit card form. There is a $30.00 fee for returned checks. There are no service refunds. You agree that your credit card on file will be automatically charged for any ETFW invoice generated such as your visit fee or if a supplement order or lab order is requested. You also authorize ETFW to automatically charge your credit card for any missed appointments or late cancellations of less than 24 hours in advance at the full service fee. There is no charge for rescheduling or canceling appointments more than 24 hours in advance. I am also responsible for any chargeback fees if for some reason my credit card is declined. This authorization is part of my records and will be treated with privacy, confidentiality and respect.

**Additional time charge:** If a visit goes over the scheduled time (ex. 1 hour) then there will be an additional visit charge in 15 minute increments at the prorated rate. Your credit card on file will be charged after the visit is complete.

**Refunds:** Supplements and Lab work is purchased through outside vendors and ETFW can not issue any refunds, please only purchase items you intend to use. At ETFW you may receive a refund for a service that was prepaid but not used and cancelled with the 24-hour notice before the appointment. There are no refunds for services that have already been fulfilled (ex. after a visit). If you purchase a set of visits/services for a discount in a "package plan" and decide to not use them all - you may receive a partial refund for any remaining balance after calculating the used visits at the normal fee schedule. You may receive a refund for a prepaid visit if ETFW cancels the appointment and you do not wish to reschedule.

**Primary Care Physician (PCP):** Dr. Karen Austin, DC, FMACP is a Doctor of Chiropractic and specializes in functional medicine and nutrition operating within the scope of her license. Dr. Austin, DC is not a medical doctor, does not act as a primary care physician and is not on call, nor are any ETFW practitioners regardless of license type including MD/DO/DC/ND/PhD. Please maintain a positive, working relationship with your medical doctor, keep him/her informed of your healing activities and continue your regular medical care and check-ups. This applies to all providers/practitioners with ETFW.

**Photo release, Social Media release, Website and Marketing release** You agree to authorize ETFW and Dr. Karen Austin, DC, FMACP use of any public reviews (ex. Google, Yelp, Facebook, etc) that you submit or a review emailed to us. These reviews may be used for marketing activities and other online promotions via social media, websites and all printed or digital publications and media in perpetuity. You acknowledge that participation is voluntary, there is no financial compensation and this includes photos, graphics and testimonials. You release ETFW and Dr. Karen Austin, DC, FMACP of any liability or claims by me or any third party related to the use of photographs, graphics or testimonials in printed or digital media.

**Updates to ETFW Policies** All current updates to our Policies will be immediately applicable to you & all previous signers and posted on the ETFW website and in our online software. You may view them there or request an updated copy emailed to you at any time.

**Stopping Medication:** ETFW practitioners will **NOT** take you off any medication, which can only be done with your prescribing physician. If your goal is to decrease your need for medication, we can suggest a protocol to encourage health and then you may work with your MD to monitor your progress and see if you are able to lower or eliminate your medication dosage over time. Keep your MD informed.

**Emergencies:** In case of an emergency, call your PCP, visit your local urgent care or call 911.