1. I agree to reach out to Naz Maduro Nutrition LLC to schedule or re-schedule appointments and only contact my dietitian for nutrition matters.
2. I understand that voicemail is checked once every 24 hours Monday through Saturday. Voicemail and e-mail are NOT checked on Sunday.
3. I will use e-mail for concise communication of administrative issues such as rescheduling an appointment only.
4. I will not use e-mail to discuss the course of treatment and/or diet planning. If I have a question about the course of my care, I need to schedule a session with my nutritionist through the scheduling system, phone or email. Each nutritionist-dietitian at Naz Maduro Nutrition has the discretion to address the questions received or wait until the next appointment or schedule an earlier session than agreed upon during correspondence.
5. I agree that I will cancel or re-schedule my appointments no later than 24 business hours in advance. If I am unable to do that I agree to pay for the missed/cancelled or re-scheduled appointment.
PATIENTS USING INSURANCE
I understand I am responsible for knowing how my insurance policy works and for presenting any necessary referrals or other documents to my healthcare provider. I am responsible for all copayments, co-insurances and deductibles at the time of service. I am responsible for all costs of services provided if a valid referral from my doctor is needed, but not provided to Naz Maduro Nutrition, my insurance policy is not in effect, or the dietitian-nutritionist does not participate with my insurance. Payment is expected in full at the time of the visits. I authorize the release of medical information necessary to process insurance claims to insurance companies or their agencies (including Medicare) for the purposes of filing and payment of medical claims. I authorize payment of medical benefits to the provider. I permit a copy of this release to be used in place of the original.
Initial appointments last up to 60 minutes and follow-up appointments last up to 30 minutes. Our dietitians greatly value your time and theirs. Initial or follow up appointments missed or cancelled with less than 24 hours notice will be subject to a $150 cancellation fee.