Prospective Patient Readiness Assessment 

Thank you for your interest in becoming a patient of Wellness ReSolutions!  We'd like to learn a bit more about you, and share information with you about our practice policies as well.  We'll use this assessment to evaluate if we're a good fit to help you achieve your health and wellness goals.  
Note: If you are unable to answer "yes" to each of the policy questions, please understand that we will not be able to accept you as a patient.

Patricia A. Morton, MD, Grant Dula, PA-C, & The Wellness ReSolutions Team
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Please enter your first name. *
Please enter your last name. *
Please enter your date of birth. *
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Please enter your preferred phone contact method. *
Please enter your contact phone number *
Please enter your email address  *
Please enter your gender assigned at birth.  *
What are your top 3 wellness goals? *
How willing are you to make changes in your life? *
How confident do you feel in your ability to make changes? *
How much support do you have from friends and family for making changes? *
How clear are you on the specific changes you want to make? *
How prepared do you feel to take action towards making changes? *
At Wellness ReSolutions, we use LabCorp exclusively for all of our laboratory needs. Do you accept our laboratory policies? *
We are not in network with any health insurance. We do not submit claims or communicate with insurance companies or their agents regarding your care, payment for your care, or prior authorization of prescriptions. Do you accept our insurance policies? *
Wellness ReSolutions providers do not serve as primary care providers. You must maintain a relationship with a primary care physician for acute care, routine care, and age-appropriate screenings. Do you accept our primary care requirement policy? *
To remain "active" for prescription refills and practitioner support via the patient portal, you must:

- Complete an office or telemedicine visit with a provider every 6 months; 

- Be seen in person by a provider every 12 months; 

- Have a full set of labs and an annual consultation with a provider every 12 months. 

Prescriptions and prescription refills will not be approved by providers if you do not have a future appointment scheduled. Do you agree to our remaining active policies?
 *
Prescriptions will only be written for "active" patients who have a scheduled appointment with a provider. Prescriptions will be written for no more than 6 months. No early refills will be given for controlled substances (e.g. testosterone). Wellness ReSolutions is not responsible for damaged, lost, or stolen prescriptions. Do you agree to our prescription policies? *
We have cash pay and insurance pay options for blood work/labs, which will be required before your initial appointment. 

Cash Pay: We have secured custom pricing from LabCorp for significantly discounted lab services available through our office. Payment is made directly to Wellness ReSolutions and labs are either drawn in office or at a LabCorp draw center. Discounted cost of full panel of labs done prior to initial visit and annually thereafter starts at $295 and generally will not exceed $360. Note: There is a $25 draw fee for office draws. 

Insurance Pay: Labs must be drawn at LabCorp and order will be electronically submitted using diagnosis codes in order to submit insurance claim. You will provide payment to LabCorp directly based on insurance. 

Please note: We cannot guarantee that your labs will be covered to any degree (or at all) if using insurance. It is your responsibility to review your plan's coverage for these labs. If coverage is denied, your out-of-pocket cost could be as high as $2000 for a full panel. Once the blood draw is completed, no changes in your payment option can be made.

What is your preferred method of drawing labs? *
How did you find our practice? *
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