Patient Status

• Self-Pay (Not submitting to insurance)

Description of Services

This estimate covers anticipated charges related to concierge hormone and/or metabolic care.

Expected Services May Include:

• Initial Consultation

• Ongoing Membership Oversight

• Laboratory Review & Interpretation

• Prescription Management

• Telehealth Follow-Up Visits

Estimated Charges

Initial Consultation: $150.

Included in membership if joins.

Monthly Membership (if applicable): $129

Estimated 3-Month Total (if enrolling): $387

Medication costs are separate and vary depending on dosing and pharmacy selection.

Laboratory testing costs may vary depending on panel ordered.

Important Information

This Good Faith Estimate shows the expected costs of items and services that are reasonably anticipated.

The final charges may differ based on:

• Clinical findings

• Changes in treatment plan

• Medication adjustments

• Additional labs required

You have the right to receive a Good Faith Estimate for the total expected cost of non-emergency services.

If you are billed at least $400 more than this estimate, you have the right to dispute the bill.

For questions or to initiate a dispute, visit:

www.cms.gov/nosurprises