We'd like to welcome you to Uhling Consulting, LLC and are thrilled join you on your journey of health and wellness! Uhling Consulting’s Registered Dietitians (RDs) offer a private setting for one-on-one nutrition counseling. Our RDs strive to help you create a more healthful life through individual behavior and lifestyle changes by providing guidance to manage or prevent medical condition(s), minimize existing symptoms, enhance energy levels and positively affect weight, body composition and laboratory values.  We value your time, health and needs and aim to provide the up-most care and attention, so we ask that you as our patient and involved health care partner to agree to your patient responsibilities below. 

HIPAA Privacy and Release of Information Authorization

As a patient of our practice, I hereby authorize Uhling Consulting, LLC and its affiliates, its employees and agents, to use and disclose protected health information (e.g., information relating to the diagnosis, treatment, claims payment, and health care services provided or to be provided to me and which identifies my name, address, social security number, Member ID number) for the purpose of helping me to resolve claims and health benefit coverage issues.  I understand that by consenting to treatment my provider may access any available information regarding health data and/or insurance information including but not limited to specific insurance eligibility and benefits through my plan, medications, or other records released to the practice related to my care.

Patient Financial Responsibility

I. Financial Policy
I understand and acknowledge that I am responsible for any amounts not covered or payable by my insurance and that I am responsible for all charges regardless of insurance coverage. I agree to pay my account with this office in accordance with the contractual agreements with my plan and all payment terms within this office. I assign benefits to this office in accordance with billed services and agree to pay any patient responsibility including but not limited to deductible, co-payment or co-insurance as determined by my insurance plan and that once processed through insurance I waive my right to choose any discounts offered by Uhling Consulting, LLC as contractually required by my plan. Any payments owed will be due at the time of service unless otherwise stated by Uhling Consulting, LLC. Many insurance companies have additional requirements or stipulations that may affect coverage(s), it is my responsibility to understand those requirements and/or stipulations. If my account balance goes unpaid and reasonable attempts have been made to collect is referred for collections, I agree to pay reasonable collection expenses including attorney’s fees.

II. Appointment Policies
Our appointments range between 60 to 90 minutes and that is allocated specifically and ONLY for you.  We ask that just as we respect your time, you respect ours and provide the requested notice (see below) for any appointment change requests.   

Weekday (Monday - Friday) Appointments:
Uhling Consulting LLC requires a minimum of 48-hour notice from our patients when canceling or rescheduling a weekday appointment (Monday - Friday). Failure to cancel/reschedule within 48 hours of your scheduled appointment will result in a $100 FEE per infraction. Payment MUST be made prior to scheduling another appointment.

Saturday Appointments:
Uhling Consulting LLC requires a minimum of 48-hour notice from our patients when canceling or rescheduling a Saturday appointment. Failure to cancel/reschedule within 48 hours of your scheduled appointment will result in FULL PAYMENT FEE ($150 - initial visit // $100 - follow-up visit) per infraction. Payment MUST be made prior to scheduling another appointment. Saturday appointments are a service we offer to help accommodate patients‘ schedules.

Late Policy:
Uhling Consulting LLC requires that patients are on time for the scheduled appointment. If you are more than 15 minutes late for your appointment, you will be considered a “No-Show” appointment and incur a "No Show" Fee (see above policies). If you are running late or know that you will not be able to make your appointment, please call the office at 602.341.5248 to avoid fees and to reschedule your appointment.

**A patient who fails to present to a scheduled appointment three times may be dismissed from the Practice.**

III. Bariatric Policy
In order to accurately assess a patient’s readiness for bariatric surgery, Uhling Consulting LLC requires a minimum of two appointments (initial and follow-up) prior to providing a nutrition assessment and authorization for surgery.

Patient Acknowledgement
 
As a patient of Uhling Consulting LLC, you have read and understand the HIPAA Privacy, Financial, Appointment, and Bariatric Policies described above.  You agree to pay, promptly and in full, any amounts due to the provider, including co-payments, deductibles, and amounts due for non-covered or services that are not payable by my insurance. 
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