Consultation & Treatment Package Payment Policy
All patients who book a consultation appointment are required to pay the consultation fee immediately after the consultation.
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If a PHO medical provider prescribes a treatment package and the patient chooses to move forward, the full treatment package amount is due at the time of purchase.
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If the patient is unable to pay the full amount upfront, they must agree to an approved payment installment plan. A minimum down payment of 50% of the total treatment package cost is required to begin the installment plan.
This is PharmXHealthOne company policy.
PharmXHealthOne Consents, Policies, and Acknowledgments
New Patient Forms, HIPAA Notice, Consents, Policies, and Acknowledgments
Welcome to the PharmXHealthOne Integrated Medical Clinic consents, policies, and acknowledgments page. This page gives patients access to the required new-patient forms, HIPAA Notice of Privacy Practices, consent forms, financial policies, refund and return policies, communication policies, telehealth consent, laboratory and pharmacy policies, and other acknowledgments that may apply to care at PharmXHealthOne.
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Patients may complete forms electronically through the EMR/patient portal when available. Paper completion is also available upon request. Online completion is preferred because it helps reduce wait time, improves accuracy, and allows PHO to review information before the appointment.
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By signing the PharmXHealthOne New Patient Registration, Health History, HIPAA Notice, Consent and Policy Acknowledgment form, the patient confirms that these documents have been made available, that the patient has had the opportunity to review them, and that additional treatment-specific forms may be required before certain services, treatments, medications, procedures, laboratory orders, injections, infusions, hormone therapy, weight-loss therapy, peptide-related therapy, compounded medications, aesthetic services, or other care.
Important Patient Notice
Please read the documents that apply to you before signing any acknowledgment or consent form. Do not sign a form if you do not understand it. Questions may be directed to PHO staff or the treating provider before signing.
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These forms do not guarantee that PHO will provide any requested treatment, medication, prescription, laboratory order, procedure, product, program, or service. Clinical eligibility is determined by the PHO medical provider based on history, examination when applicable, laboratory results, safety, medical necessity, contraindications, provider judgment, scope of practice, and applicable law.
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If a patient declines to sign required forms or acknowledgments, PHO may be unable to schedule, evaluate, prescribe, treat, or continue care, except as otherwise required by law.
Required New Patient Documents
Please review the following documents:
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Required New Patient Consent, Policy, and Acknowledgment Forms
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Treatment-specific consent forms, if applicable
HIPAA Notice of Privacy Practices
PHO makes its HIPAA Notice of Privacy Practices available to every patient. This Notice explains how PHO may use and disclose protected health information, also known as PHI, for treatment, payment, healthcare operations, and other purposes permitted or required by law. It also explains patient privacy rights, PHO’s legal duties, and how to contact PHO with privacy questions or complaints.
Patients may request a paper copy of the HIPAA Notice at any time.
Required Consents, Policies, and Acknowledgments
PHO makes the required new-patient consent, policy, and acknowledgment forms available to patients before non-emergency evaluation or care. These forms may include:
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General Consent for Evaluation and Treatment
Telehealth and Remote Care Consent
HIPAA Notice of Privacy Practices Acknowledgment
Electronic Communications Consent
Patient Portal Access, Use, Communication, and Security Agreement
Cash-Pay Financial Responsibility and Third-Party Billing Agreement
Good Faith Estimate and Self-Pay Patient Notice
Laboratory Testing, Specimen Collection, and Required Monitoring Consent
ePrescribe, Pharmacy Communication, and Medication History Consent
Authorization to Release or Discuss Medical Information, when applicable
No-Refund, Final-Sale, and Non-Returnable Services Agreement
Appointment Cancellation, Late Arrival, No-Show, and Scheduling Policy
Payment Authorization, Card-on-File, Subscription Billing, and Chargeback Policy
Patient Rights, Responsibilities, Emergency, Urgent Care, and Primary Care Limitation Acknowledgment
Functional Medicine, Preventive Care, Natural Medicine, Wellness, and Scope-of-Practice Disclaimer
Compliance, Privacy, PHI Safeguards, and Practice Operations Acknowledgment
Global New Patient Acknowledgment and Agreement
View Full New Patient Consent and Policy Packet
Download Required Consent and Policy Packet PDF
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See Forms and Policies Page for other PHO Policies, Consents, and PHO Discrlaimers
Refund, Return, and Product Policy
At PharmXHealthOne, we are committed to delivering safe, effective, and personalized healthcare. Due to the nature of our services and custom-prescribed medical products, we uphold the following policies regarding refunds, returns, and subscription billing.
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Product Refunds and Returns
All medication and wellness product purchases from PharmXHealthOne are final sale and non-refundable. This includes, but is not limited to:
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Prescription medications
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Compounded treatments
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Nutraceuticals and supplements
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Hormone therapies
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Peptide and injectable treatments
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Our medications are compounded and prescribed specifically for each patient, based on individual medical assessments. For this reason, we cannot accept returns or issue refunds for any product once the order has been placed.
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Patients should review all pricing, product, prescription, subscription, and treatment information carefully before payment or order placement. Questions should be directed to PHO staff before ordering or purchasing.
Treatment-Specific Forms
The new-patient forms and global acknowledgment do not replace treatment-specific consent forms. If a patient receives or requests a specific treatment, service, medication, infusion, injection, procedure, device-based treatment, hormone therapy, weight-loss therapy, peptide-related therapy, compounded medication, IV therapy, aesthetic service, or other service, PHO may require additional treatment-specific consent forms and instructions.
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Treatment-specific consents may include additional risks, contraindications, no-refund terms, monitoring requirements, expected follow-up, lab requirements, and instructions that are not repeated in the general new-patient packet.
Emergency and Urgent Care Notice
PHO is not an emergency provider and should not be used as a substitute for 911, emergency room care, urgent care, hospital care, or crisis services.
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If you are experiencing chest pain, severe shortness of breath, stroke-like symptoms, severe allergic reaction, severe bleeding, severe infection, suicidal thoughts, loss of consciousness, or any medical emergency, call 911 or go to the nearest emergency room immediately.
Do not wait for a PHO appointment, portal message, voicemail reply, prescription, or callback for emergency symptoms.
Questions
For questions about forms, policies, privacy practices, billing, or patient onboarding, please contact:
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PharmXHealthOne Integrated Medical Clinic
2828 S Seacrest Blvd, Suite 216
Boynton Beach, FL 33435
Phone: (561) 778-8121
Email: health@pharmxhealthone.com
Website: www.pharmxhealthone.com