MEMBERSHIP TERMS

WEIGHT MANAGEMENT

SELV HEALTH & AESTHETICS

• We are currently only servicing patients that will be physically located in Georgia at the time of their visits. 

• Results are not guaranteed and individual results will vary. 

• All fees are non-refundable and non-transferable. 

• Pricing is subject to change. 

• Selv Health & Aesthetics does not bill insurance or bill Medicare or Medicaid. Selv Health & Aesthetics requires payment before the time of service and uses memberships following the initial consultation. 

INITIAL CONSULTATION

Initial consultation $150, will include: 

• Virtual visit with a provider

• Determination of eligibility for program

• Detailed program explanation

• Lab order and/or review

• Prescription coordination (when clinically appropriate)

All new patients must complete an initial consultation. The initial consult is used to review details of the membership program and to determine eligibility. A thorough review of medical and family history is required. 

Patients younger than 18 or older than 65 years old are not eligible for membership.

Patients with the following current conditions are not eligible for membership:

• Pregnancy

• Symptoms of thyroid disorder

• Renal impairment 

Patients with the following past medical history are not eligible for membership: 

• Gastroparesis

• Pancreatitis

Patients with the following family history are not eligible for membership: 

• Thyroid cancer (specifically medullary thyroid carcinoma)

• Multiple endocrine neoplasia syndrome type 2

Medical eligibility does not guarantee entry into the program. Program eligibility is at the discretion of the provider. Prescriptions are not guaranteed following the initial consult. Prescriptions must be deemed medically appropriate and the necessary lab results must be available for review before consideration for a prescription. If lab results are not available, a lab order can be provided or previous lab results can be uploaded into the patient portal. Lab orders can be taken to a local lab of your choice and results will be linked to your patient portal. Only labs completed within the past year are accepted and depending on the results or past medical history, more recent labs may be requested. Once the necessary labs are completed and/or reviewed, prescription eligibility will be determined and if eligible a prescription will be sent to the pharmacy of your choice. *Fees do not include medication or lab charges. Medication or lab charges will be managed separately by the pharmacy or lab. Several medication manufacturers offer discounted pricing self-pay patients. Information regarding self-pay pricing can be located at www.selvhealth.com.  If you are commercially insured, you may attempt to use your health insurance for your prescription. Please note insurance coverage does not guarantee prescription coverage and it is recommended to contact your insurance company prior to scheduling the initial consultation if you are interested in prescription coverage as payments are non-refundable and non-transferrable.

MEMBERSHIP

$150 monthly membership fee, will include: 

• Monthly virtual visits with a provider 

• Prescription coordination (when clinically appropriate)

• Ongoing concierge support via a private portal

It is recommended to follow up with a provider after starting medication for weight management. If you desire to continue care with our office following the initial consultation, a membership will be required. If a prescription was provided following the initial consult, a membership is required for refills. *Refills/prescriptions will only be provided during office visits following the initial consultation. No refills will be provided outside of office visits. *Fees do not include medication or lab charges. Medication or lab charges will be managed separately by the pharmacy or lab. Several medication manufacturers offer discounted pricing for self-pay patients. Information regarding self-pay pricing can be located atwww.selvhealth.com.

RECURRING CHARGES

Membership requires authorization of monthly recurring charges via a stored payment on file.  Payment methods are stored within a secure third-party payment processor contracted with the electronic medical records platform. Monthly membership fees cover office visits only. Medication charges will be charged and managed separately by the pharmacy. Lab charges will be charged and managed separately by the lab if applicable. Recurring charges for membership will occur monthly on the 25th of each month.

CANCELLATION OF MEMBERSHIP

Memberships must be canceled by the 10th of the month to avoid being billed on the 25th of that month. Memberships can be canceled and payment authorization revoked per request via the secure patient portal. Members will need to send a message via the secure patient portal requesting that the membership be canceled. If the request for cancellation of membership is submitted after the 10th of the month, the member’s stored payment will receive a final charge on the 25th of that month.

FAILED PAYMENTS

Failed payments will result in the member being ineligible to schedule, or if the member is already scheduled, the appointment(s) will be canceled. No advance notice will be given prior to canceling appointments for failed payments. If there is no updated stored payment and successful payment within 30 days of the failed payment, the member’s membership will be canceled. No advance notice will be given prior to canceling memberships for no updated stored payment following a failed payment.

LATE CANCELLATIONS/NO-SHOWS

A late cancellation is defined as canceling or modifying an appointment with less than 24 hours notice. A no-show is defined as being unavailable for your appointment at the scheduled time with no notice.  Members not available for their appointment within 10 minutes past the scheduled appointment time will be determined as a no-show. Both late cancellations and no-shows will result in the member’s stored payment being charged a $150 late cancellation/no-show fee. The late cancellation/no-show fee is separate from monthly membership fees and do not satisfy monthly membership fees. The monthly membership fee will be charged as schedule in addition to the no show fee, unless membership is canceled according to the membership terms.

Initial consult fees and/or monthly membership fees will not be refunded if the patient is unable to reschedule due to a late cancellation or no-show. Two no-shows may result in membership cancellation.