Dr. Justin Marchegiani D.C.
Phone: (512) 535-1817
Welcome! And thank you for choosing Dr. Justin as one of your health care providers.
HOW THE PROCESS WORKS:
During your initial consultation Dr. Justin will review your health history and make recommendations for lab tests that are appropriate for your specific health issues.
Once you have completed your lab tests, Dr. Justin will explain the meaning of your test results to you in a follow up consultation. He will create an individualized therapeutic program for you including diet changes, nutritional supplements, and exercise, lifestyle and stress management advice.
Subsequent consults are scheduled to monitor your progress. Dr. Justin will also design an on-going wellness program to be reviewed and updated with our staff at no charge every six months. We invite you to contact us via email or phone should you have any questions during the course of your treatment.
We look forward to assisting you in achieving your current wellness goals, and to guiding you in maintaining wellness throughout your life.
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Dr. Justin and the Wellness Team!
New Patient Paperwork
I clearly understand and agree that all services rendered to me are charged directly to me and that I am responsible for payment. I also understand that if I suspend or terminate my care and treatment, any fees for professional services rendered to me will be immediately due and payable. I authorize Dr. Justin Marchegiani to release my personal medical information to me.
Please answer all questions frankly, to the best of your knowledge. All information is confidential.
Please circle the appropriate number on all questions below, 0 as the least or never to 3 as the most or always.
Category VI (Cont.)
Category XV (Cont.)
Category XVI (Males Only)
Category XVII (Males Only)
Category XVIII (Menstruating Females Only)
Category XIX (Menstruating Females Only)
Your first consultation will be 45 minutes – 1 hour on average $299. During this time Dr. Justin will determine the appropriate lab tests you should order to address your specific health concerns.
New Patient consultation: $299 (45 minutes - 1 hour) on average.
45-60 minutes: $200
30-45 minutes: $150
15-30 minutes: $100
1-15 minutes $50
Follow-up consults may be scheduled in 15, 30, 45, or 60-minute blocks of time. We encourage you to book your appointments 4 weeks in advance. As a courtesy to you, our office will email you 3-7 days in advance to remind you of your appointment.
The results of your lab test(s) will be sent to Dr. Justin 2 to 4 weeks after mailing your specimens to the lab Dr. Justin will evaluate the results. After evaluation you will be contacted to schedule a follow-up appointment.Certain blood work can be billed to the patient’s insurance, this is dependent upon the type of insurance you have as well as your deductible. When insurance is not available, cash discount options can be used to purchase blood work. The patient is responsible for any lab work their insurance does not cover.
If you are unable to keep your scheduled appointment, you must notify our office a minimum of 48 hours before your scheduled time or you may be charged for that appointment. Dr. Justin has patients waiting months to be seen, and a missed appointment takes time away from someone else.
If The Doctor Is Running Late
You must be available for the entire time of the consult. The Doctor maybe running late with his previous patient, you will be charged a missed consult fee equal to the value of the consult if you are not available.
All receipts given at check out contain cpt codes and IC10 codes that that can be submitted to your insurance company for reimbursement. The easiest way to do this is by calling the customer service number on the back of the insurance card to receive instructions regarding the submission of your claim.
The Doctor is not responsible for any insurance claims that are not reimbursed. If there are any changes to a super-bill that need to be made, it is the responsibility of the patient to find out from their insurance what needs to be amended. The office will make adjustments to the super-bill at $5 fee per receipt. Any in depth paperwork that requires that Doctor to fill out will be charged to the patient at the doctors hourly rate.
Communication Outside of Scheduled Consultation
have read and understood Dr. Justin’s Policies and Procedures.
authorize Dr. Justin Marchegiani to charge my credit card as listed below. Please attach a copy of your insurance card front and back if Dr. Justin has requested it.
This authorization may be revoked at any time when the following stipulations have been performed: