Flagstaff Functional Medicine

Welcome to our functional and integrative medicine practice. We are glad you’re here. We take pride in the high level, holistic care we offer, which is above the traditional standard of care. Please take the time to read through our office and financial policies to understand our unique structure, offerings, and expectations.

Office Policies & Guidelines

We are a micro-practice model. This means that we operate with a low overhead to allow more time for patient care and support a healthy work-life balance for our practitioners. Our primary method of communication is the patient portal. Our office phone serves as secondary. We aim to return calls/texts/portal messages within 1 business day. Our portal is set up for you to do everything you need to do- schedule, cancel appointments, make payments (we collect your balances to your card on file at the time of visits unless otherwise already paid), portal messaging to our team, viewing labs, documents, and handouts, tracking vital signs and health data.

Active Participant

We expect our patients to be the driver of their health and wellness journey. This means you come to your visits prepared, are eager to learn and understand your labs and plan of care. Dr. Beth shares her knowledge and serves as your guide. We love to educate and empower our patients for health and wellness.

Billing Model

We are structured as a fee-for-service clinic meaning we bill for Dr. Beth’s time for all services.

Insurance Billing

We are a cash pay practice and do not bill insurance for your visits or labs.

Supplements/Vitamins

The cost of supplements are not covered as part of office visit charges. It is your choice to choose where you buy your supplements. Our company does make a small profit from online supplement sales. We offer every patient a 10% discount through our online supplement store, Fullscript. It is your responsibility to check the ingredient list to ensure you do not have an allergy to the supplement recommended to you. We cannot accept refunds for supplements purchased via Fullscript.

Lab Orders

I acknowledge that lab orders will only be completed during office visits. Labs are ordered only for patients who are working with Dr. Beth directly on a health plan. Dr. Beth reserves the right to refuse ordering a test that is not medically necessary or out of her scope of practice.

Review of your medical records

I acknowledge that there is a fee for Dr. Beth to review my medical records from other doctors. We do not routinely request medical records from your other providers as their labs and information rarely impacts our decision making. We expect patients to share any recent (less than 6 months) labs via the portal if it is something you want us to consider in your upcoming visit. Our charge is $50 per 15 minutes of record review.

You are welcome to upload former labs into your portal to be used as a reference during appointments.

Administrative paperwork

I acknowledge that a 15-minute office visit is needed for FMLA, school/work notes, medical necessity letters requiring Dr. Beth's signature. If this is something you need, please be sure to request this or have the paperwork at the time of your office visit.

Portal Messaging

Portal messaging is included with the Foundational Assessment purchase for 2 months. Portal message Dr. Beth will get a response within 1 business day. I also understand that all staff can see my portal messages.

Accessibility to Lab Reports

Per the Cures Act put into effect on April 1, 2021 all labs will be made viewable on the portal upon receipt by our EHR. Please feel confident that our policy is to reach out to patients with any critical lab values. Dr. Beth encourages you to discuss these results with her at your scheduled follow-up prior to beginning any new or modified treatment. Please ask for guidance in adjusting your supplements based on lab values before doing so.

Financial Policies & Expectations

Credit Card on File:

We require a credit/debit card on file in order to schedule any type of appointment, including consultations. This payment card is stored in our secure system and we cannot see your full card number. Your card is conveniently used to pay for office visits, membership fees or past due amounts. You have the option to update your credit card on file at any time using the Invoices/Payments tab in your portal.

Late Cancel/Missed Appointment Fees:

Out of respect for our practitioners and other patients, it is our policy to charge your card on file for late cancellation (72-hour notification) or missed appointments $75. Our scheduling system sends out reminders for your visit so please pay attention to them for accuracy in date/time. If you show up late to your appointment, your practitioner will use the allotted time left, but you may be asked to reschedule at the practitioner's discretion.

Payment due at time of service:

It is the policy of Flagstaff Functional Medicine that payment is due at the time of service unless other financial arrangements are made in advance.

Outstanding balances:

It is our policy to charge any outstanding balances to your card on file in the event that payment was missed at the time of service.

Time-based service charges:

Flagstaff Functional Medicine bills for services based on time spent for your care and the complexity of your visit. This includes visit prep, review of labs, review of records, one-on-one visit time, and post-visit work to wrap up your plan.

Lab Billing:

Our default billing for functional lab testing is patient pay. We have found that insurance companies do not find medical necessity in checking many of the labs we need to see in order to optimize your health and wellness. Therefore, we have agreements with labs for cash pay lab panels ranging from $275-$400 (individualized to your history and exam). If you request your insurance to be billed for your labs, you take full responsibility for the lab bill. (It is not uncommon for insurance to deny a Vitamin D level and the patient pays $200+ for that one test).

Informed Consent for Diagnosis and Treatment:

The intent of this consent form is to help patients, clients, and authorized representatives become better informed so that they may give or withhold consent to undergo diagnosis and treatment after having the opportunity to discuss health concerns, including potential benefits, risks, and treatment alternatives.

I acknowledge the opportunity to read and inquire about this consent and all the items addressed herein and hereby authorize Dr. Beth Claxton, MD, IFMCP and associates/contractors, in accordance and within the scope and limits of their clinical license, to perform or recommend any of the following procedures for diagnosis/treatment:

• Office Locations: You consent to treatment at this office (or any other satellite office under common ownership).
• Common diagnostic procedures: such as venipuncture, x-rays, laboratory, ultrasounds, imaging tests
• Alternative Diagnostic Procedures: including diagnostic methods, functional laboratory testing, and devices that may fall outside the "conventional standard of care".
• Medical Nutrition: therapeutic nutrition, nutritional supplementations.
• Botanical Medicine: medicinal herbs and plant derivatives prescribed as loose teas, alcohol or glycerine tinctures, capsules, tablets, creams, suppositories, etc.
• Minor Office Procedures: wound dressing, ear cleansing, sutures, biopsies, holistic pelvic care, pelvic exams.
• Lifestyle and Wellness Counseling: to promote improved wellness through lifestyle strategies, including recommendations for dietary changes, sleep, exercise, stress management, work-life balance, self-care, and developing and nurturing healthy relationships. This excludes specific treatment for known or suspected mental illness.
• Prescription Medications: as allowed by the clinicians licensure and for both FDA-approved and non-FDA approved (i.e. "off-label") applications.
• Hormonal Replacement: oral and transdermal hormonal applications intended to restore symptomatic patients to levels at age-appropriate hormone levels through bioidentical, synthetic, and animal-derived preparations.
• Group Counseling & Coaching: to facilitate efficient and effective community creation and education regarding the diagnosis, treatment, and management of health concerns and ongoing health education.

Informed Consent:

Patient or Representative acknowledges the right, opportunity, and responsibility to ask questions and to become informed regarding the clinician's diagnostic and treatment recommendations to his or her satisfaction. The patient acknowledges that all questions asked have been fully answered by the clinician.

Potential Risks: Patient or Representative acknowledges and accepts that there are risks to the diagnosis and treatment measures that fall within and outside the conventional standard of care and that these risks may include: unintended exacerbation of symptoms, new symptoms, allergic and other unintended injury and side effects from exercise, lifestyle modifications, dietary modifications, herbal and nutritional supplements, injected or intravenous therapies, hormonal therapies, adverse interactions with drugs, herbs and/or nutrients. The specific risks associated with the proposed procedures have been explained to the patient and/or the patient's representative.

No Guarantee of Potential Benefits: Patient or Representative acknowledges that treatment may result in the restoration of health and optimal functional capacity, relief of pain and symptoms, injury and disease recovery, and prevention or reversal of disease or disease progression, but ALSO acknowledges that no expressed or implied guarantees or representations can or have been made by the clinician or any affiliated staff regarding the cure or improvement of the patient's condition.

Limitations of Full Disclosure:

Patient or Representative acknowledges that the clinician cannot know or anticipate and explain every possible risk or complication, and that the patient or representative willingly chooses to rely on the clinician to exercise their best judgment within the bounds of their licensure for any of the above.

Responsibility to Report Possible Pregnancy:

Patient or Representative agrees to alert the clinician should she suspect that she is or may be pregnant in acknowledgment that some of the diagnostic or therapeutic techniques could present risks to a pregnancy.

Disclosure Coverage:

Patient or Representative acknowledges and agrees that consent form will cover the entire course of treatment for the present condition and for any future condition(s) for which treatment is sought.

Willing Participation:

Patient or Representative understands that the patient is free to discontinue participation in any and all aspects of the medical care provided by the clinician at any time and that the patient or representative is responsible for informing the clinician of the adherence to or discontinuation of any and all aspects of care and that the choice to discontinue treatments may create the risk of adverse effects for which the patient or representative bears full and sole responsibility.

Clinician Collaboration:

Patient or Representative understands that the clinician may consult with preceptors, clinical student residents, and colleagues related to the care provided and that the patient or the patient's authorized representative have the right to decline their presence or involvement during any aspect of the patient's care.

Agreement to be Contacted:

Patient or Representative understands and accepts that the clinician or affiliated staff may contact the patient or representative (e.g., by portal message, phone, email, voicemail, SMS text message) to consult or exchange information related to the patient's care.

Remote Consultations:

At times, consultation may be provided remotely and without direct contact with the clinician. In such cases, the patient or their representative agrees to maintain direct contact with a licensed healthcare provider that is appropriate for the patient's age, gender, and known or suspected health conditions.

Medical Record Keeping and Privacy:

Patient or Representative understands that records of the health services provided will be kept for a minimum of three, but no more than ten years after the date of the last visit or consultation. The patient or representative also acknowledges that information within the record may be analyzed for research purposes and that in such case, the patient's identity (name, address, exact birth date) will be kept confidential. Otherwise, this record will be kept securely and confidentially and without release to others unless so directed by the patient or representative, or as may be required by law or as necessary for insurance claim or other payment processing.

Patient's Responsibility to Disclose Information:

Patient or Representative understands that the patient bears full responsibility for any adverse effects experienced during or after the course of treatment that were reasonably deemed to be caused or related to a deficit in the full, accurate, and timely disclosure of symptoms and other medical information to the clinician to the best of the patient's or representative's ability.

Responsibility for Payment:

Patient or Representative understands that some or all of the recommended diagnostic and treatment measures may fall outside the conventional standard of care and may not be approved or covered by the patient's insurance because the services rendered fall outside the "standard of care," and in such event, that the patient accepts full responsibility for all associated costs and fees.

Dispute Resolution:

Patient or Representative agrees that short of overt negligence or malpractice, that any complaint or dispute that arises related to the diagnosis or treatment from clinician will be settled through binding mediation in the state in which the clinician is licensed.

Assignment of Benefits (Insurance/Third Party Billing):

I hereby assign benefits for medical services, which I am entitled to. I hereby authorize and direct my insurance company to issue payment to Beth Claxton, MD, IFMCP for services provided by Dr. Beth Claxton, MD, IFMCP and associations/contractors to me and/or my dependents.

I have read the above office and financial policies. I also understand these policies may be amended.