Expedited New Patient Forms
Expedited appointments do not include a comprehensive exam. It is a focused medical clearance to approve you for a specific service only (IV, Joint injections, HOCATT, HBOT, LDA). Once approved, your clearance is valid for 6 months. A follow-up consultation is required every 6 months to continue services. 

If you would like a comprehensive functional exam please complete these forms instead: https://forms.gle/HFKsQUDomSaBMAUD9
Full Legal Name *
Date of Birth *
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Phone number *
Email *
Address *
Occupation/Employer *
Emergency Contact (Name, Relationship, Number) *
Insurance is NOT billable for expedited services. Fees are due at the time of scheduling:
Initial consultation $400       Follow-up visits $200                                                                  
All services must be prepaid at the time of scheduling. They are nonrefundable, non-transferrable, and expire 12 weeks from the date of purchase.
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Cancellation/Refund

If an 8 week or greater notice is given, you will receive a 75% refund

If 8-4 weeks’ notice is given, you will receive a 50% refund

Any notice less than 4 weeks’ notice, payment is forfeited (0% refund)

Given proper notice, appointments can be rescheduled:

As a courtesy, you will receive appointment confirmation notices starting 1 week prior to your appointment. If you need to reschedule, please let us know then (1 week in advance) so we can reschedule. Less than a weeks’ notice will result in forfeit of your payment.

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As a functional clinic we have numerous patients who are sensitive to chemicals, fragrances, or who have breathing/asthma issues. We kindly ask you to refrain from strong perfumes, oils, smokes, or other strong scents while in the office. 

Thank you for your cooperation!  

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CONSENT TO TREAT: I, the undersigned patient, hereby authorize Dr. St. Petery and her staff to administer diagnostic testing, procedures, and treatments as considered necessary based on the findings during the course of the examination and treatment. I hereby certify that I have read and fully understand the above Consent to Treat. I also certify that no guarantee or assurance has been made as the end results following my treatment. *
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