Service Agreement

Thank you for considering my services. Please carefully review the service contract below. By scheduling your first appointment, you confirm that you have read, understood, and agreed to the terms and conditions outlined in this contract.

Services. The practice provides medical care in the field of lifestyle and obesity medicine through a direct specialty care practice model (DSC). In exchange for a one-time enrollment fee ($100) and monthly membership fee ($200 per month), the practice agrees to provide the patient with the following services under the terms and conditions described in this agreement:

1. Comprehensive medical and metabolic assessment

• Detailed history and physical examination: includes assessing weight history, diet, exercise habits, sleep patterns, and comorbidities.

• Laboratory testing: evaluation of metabolic markers (e.g., lipid profile, HbA1c, thyroid function), inflammatory markers, and other relevant labs.

• Body composition analysis: utilizing tools such as skinfold method, bioelectrical impedance or DEXA scans to assess fat mass and distribution.

• BMI and waist circumference measurement and interpretation: helps identify central obesity and associated risks.

2. Personalized nutrition counseling

• Individualized meal planning: tailored caloric goals, and dietary patterns (Mediterranean, DASH, plant-based, etc.) based on the patient’s clinical status and personal preferences.

• Cultural and lifestyle considerations: adjustments for cultural dietary habits, food availability, and cooking skills.

• Medical nutrition therapy: particularly for conditions like type 2 diabetes, hypertension, or hyperlipidemia, ensuring dietary guidance aligns with medical needs.

3. Physical activity and exercise prescription

• Exercise assessments: functional capacity evaluation, fitness level, mobility, and any orthopedic limitations.

• Personalized workout plans: ranging from low-impact exercises (like walking, swimming) to structured resistance training or aerobic programs.

• Activity tracking and coaching: use of wearable devices and apps to monitor progress, support adherence, and adjust regimens.

4. Behavioral health interventions

• Motivational interviewing: techniques to encourage patient-driven goal-setting and adherence to healthy behaviors.

• Cognitive behavioral therapy (CBT): identifying and modifying unhelpful thought patterns, emotional triggers, and behaviors related to eating and exercise, weight and calorie tracking, meal replacement, time restricted eating (intermittent fasting) and other behavioral strategies when appropriate.

• Stress management techniques: mindfulness, meditation, and relaxation methods that help reduce stress-induced overeating.

• Habit formation and relapse prevention: strategies to create sustainable healthy routines and address setbacks early.

5. Pharmacotherapy for obesity and metabolic conditions

• Prescription weight-loss medications: appropriately selected FDA-approved drugs (e.g., GLP-1 receptor agonists) to support dietary and lifestyle changes.

• Medication management: reviewing existing medications that may affect weight (e.g., certain antidepressants, steroids) and adjusting them in collaboration with other specialists.

• Monitoring and follow-up: regular assessment of efficacy, side effects, and patient tolerance to ensure optimal outcomes.

6. Bariatric surgery evaluation and referral

• Pre-surgical assessment: evaluating eligibility, conducting necessary medical workups, and preparing patients for surgery.

• Referral to surgical specialists: coordinating with bariatric surgeons for gastric bypass, sleeve gastrectomy, or other procedures when indicated.

• Post-surgical follow-up: monitoring nutritional status, weight trajectory, and comorbidities in collaboration with the surgical team.

7. Management of comorbid conditions

• Chronic disease management: coordinated care for type 2 diabetes, hypertension, dyslipidemia, PCOS, and other conditions commonly associated with obesity.

• Sleep evaluation: screening for and addressing sleep disorders (e.g., obstructive sleep apnea) that can interfere with metabolic health.

• Cardiometabolic risk reduction: managing cardiovascular risk factors through medication, lifestyle changes, and ongoing monitoring.

8. Stress reduction, mental health, and emotional wellbeing

• Screening for depression, anxiety, and eating disorders: prompt referral to mental health professionals when specialized therapy is needed.

• Stress-management programs: educational sessions on relaxation techniques and stress-coping strategies.

• Mind-body interventions: supporting and counseling on practices like yoga, meditations, neurofeedback or breathing exercises as part of comprehensive treatment.

9. Lifestyle medicine counseling and education

• Smoking cessation support: tools and treatments for patients who smoke, given the added health risks associated with obesity and smoking.

• Alcohol use and substance abuse counseling: screening and referral to appropriate programs when needed. medication therapy support to manage cravings and prevent relapses.

• Holistic approaches: guidance on other lifestyle pillars—stress management, adequate sleep and social engagement.

10. Community support

• Community resource referrals: links to local fitness programs, cooking classes, or community health workers.

• Family involvement: encouraging family or caregiver participation to support lifestyle changes at home.

11. Telemedicine and ongoing support

• Virtual consultations: providing telehealth platforms for remote follow-up and real-time patient support.

• Online portals and apps: counseling on tools for tracking nutrition, physical activity, biometric data, and behavior goals.

• Ongoing monitoring and communication: frequent touchpoints (phone calls, text messages, secure chats) to reinforce adherence and address challenges quickly.

12. Long-term weight maintenance and relapse prevention

• Maintenance programs: continuous education, periodic evaluations, and updates to treatment plans.

• Behavioral reinforcement: goal setting, rewards, and accountability methods to sustain healthy behaviors.

• Regular check-ins: monitoring weight trends, dietary patterns, and physical activity to address issues before significant regain occurs.

• Addressing longevity and healthspan concerns.

Services that are not covered. The cost of medications, imaging, laboratory tests, and specialist services is not included, and you are fully responsible for these expenses. They may or may not be covered by your insurance. However, coverage may apply if they are ordered by your regular in-network primary care physician based on formal recommendations from the practice.

Term. This agreement begins on the date of the initial appointment and automatically renews on a monthly basis unless canceled by either party. Either party may terminate this agreement at any time and for any reason, with no cancellation fees, advance notice or cancellation reason required.

Payments. Your initial payment of $300—comprising a $100 enrollment fee and a $200 first-month fee—must be paid in full prior to your first appointment. Payment can be made via credit/debit card. Subsequent monthly payments of $200 will be automatically drafted from your credit/debit card on file unless and until you or the practice cancel this agreement.

Refunds. If you choose to cancel your membership before the current monthly payment cycle ends, no refunds will be issued.

Re-enrollment. If you cancel your membership or allow your monthly payments to lapse, you may re-enroll at any time—subject to practice availability—by scheduling another initial appointment and paying the $300 initial fee (a $100 enrollment fee and a $200 first-month fee) again.

Non-participation in insurance. The patient understands that the practice does not participate in any health plans, HMO panels, or other private or governmental third-party payer health plans. Accordingly, the patient is prohibited from submitting charges to, or seeking reimbursement from, any of the above for the services we provide to you under this agreement.

Medicare. We cannot accept Medicare beneficiaries as patients because the law requires a physician to be opted-out of Medicare in order to privately contract with individuals who are Medicare eligible. The practice is not opted-out of Medicare at this time, so may not enroll Medicare patients. The patient understands this and certifies that they are not Medicare beneficiaries or Medicare eligible. The patient further agrees that should they become Medicare eligible during the term of this agreement, they shall notify the practice immediately, and this agreement will be terminated upon eligibility.

Medicaid (Medi-Cal). The practice does not bill or seek reimbursement from Medicaid (Medi-Cal). Patients who are Medicaid (Medi-Cal) beneficiaries understand that they are joining the practice under private contract. Therefore, the patient is responsible for membership fees and/or fees for any additional products or services which the practice provides to you under this agreement. Neither the practice nor the patient may submit charges for such fees to Medicaid (Medi-Cal) for reimbursement. Prescriptions, lab testing, imaging, etc., which are not personally provided by the practice, may be submitted by the patient to Medicaid (Medi-Cal) or reimbursement consideration.

This agreement is not health insurance. The patient acknowledges and agrees that this agreement is neither an insurance plan nor a substitute for health insurance, and it does not meet any federal requirements for health care coverage. It excludes hospital services, emergency room treatment, and any services not personally provided by the practice. Only the services listed above are included; any service not specifically mentioned may not be covered under this agreement. The patient has been advised to maintain a health insurance policy to cover any health care services not included in this agreement.

Communications. While the practice endeavors to provide patients with the convenience of a wide variety of electronic communication options, we are careful to comply with confidentiality requirements and take seriously our duty to protect patient privacy. However, communications by email, facsimile, video chat, cell phone, texting, and other electronic means, can never be guaranteed to be 100% secure or confidential. You understand and agree that by agreeing to participate in the above means of communication, you expressly waive any guarantee of absolute confidentiality with respect to their use. You further understand that participation in any of the above means of communication is not a condition of membership in this practice and that you have the option to decline any particular method of communication. Email and text messaging are not appropriate means of communication in an emergency, for dealing with time-sensitive issues, or for disclosing sensitive information. In an emergency or a situation which could reasonably be expected to develop into an emergency, you understand and agree to call 911 or go to the nearest emergency room and follow the directions of emergency personnel.

Technical failure. The practice will not be liable for any loss, injury, or expense arising from a delay in responding to the patient when that delay is caused by technical failure. Examples of technical failures: failures caused by an internet or cell phone service provider; power outages; failure of electronic messaging software or email provider; failure of the practice's computers or computer network, or faulty telephone or cable data transmission; any interception of email communications by a third party which is unauthorized by the practice; or the patient's failure to comply with the guidelines for use of email or text messaging, as described in this agreement.

Physician absence. From time to time, due to circumstances such as conferences, patient emergencies, physician illness, vacation, the physician may be temporarily unavailable. When the dates of such absences are known in advance, the practice shall notify the patient so that they may schedule non-urgent care accordingly. In the event of unexpected physician absence, patients with scheduled appointments shall be notified as soon as practicable, and appointments shall be rescheduled at the patient's convenience. If during a physician absence, the patient should experience an acute medical issue requiring immediate attention, the patient should proceed to an urgent care or other suitable facility for care. Charges from urgent care facilities or any other outside provider are not included under this agreement and are the patient's responsibility. The patient may submit such charges to the patient's insurance or request that the outside provider do the same. We cannot guarantee insurance reimbursement.

Monthly fee and service offering adjustments. If the practice finds it necessary to increase or adjust monthly fees or service offerings it may do so after notifying the patient of any modification. If the patient does not consent to the modification, they shall terminate the agreement in writing prior to the next scheduled monthly payment.

Change of law. If there is a change of any relevant law, regulation, or rule, which affects the terms of this Agreement, the parties agree to amend this Agreement to comply with the law.

Legal significance. You acknowledge that this agreement is a legal document and gives the parties certain rights and responsibilities. You also acknowledge that you are not suffering any medical emergency. You have had a reasonable time to seek legal advice regarding this agreement and have either chosen not to do so or have done so and are satisfied with the terms and conditions of the agreement.

Entire agreement. This agreement contains the entire agreement between the parties and replaces any earlier understandings and agreements, whether they are written or oral.

No waiver. Either party may choose to delay or not to enforce a right or duty under this agreement. Doing so shall not constitute a waiver of that duty or responsibility and the party shall retain the absolute right to enforce such rights or duties at any time in the future.

Dispute resolution. We strive to provide the highest level of personalized care to each patient, but we recognize that misunderstandings can sometimes occur. We value open and sincere dialogue with our patients, especially when we fall short of expectations, and we are committed to resolving all concerns. Therefore, if the patient is dissatisfied with—or has concerns about—any services, treatments, or experiences arising from membership in this practice, both the member and the practice agree to refrain from making, posting, or causing to be posted on the internet or social media any untrue, inaccurate, or disparaging comments about the other. Instead, the patient agrees to first discuss any complaints or issues with their physician. The physician will respond to the patient’s concerns, and if the patient remains dissatisfied after this response, both parties will continue discussions in an effort to reach a mutually acceptable solution.

Arbitration. The parties agree that any Dispute that cannot be resolved through informal negotiations shall be resolved by binding arbitration administered by American Arbitration Association/JAMS under its rules in effect at the time the request for arbitration is made. The seat and location of the arbitration shall be in Contra Costa County, California, and the parties consent to personal jurisdiction therein. The arbitrator’s decision shall be final, binding, and enforceable in any court with jurisdiction.

Governing law. This agreement and any dispute, claim, or controversy arising out of or relating to this agreement shall be governed by and construed in accordance with the laws of the State of California, without regard to its conflict-of-law provisions.

Forum selection. Any legal action concerning a dispute shall be brought exclusively in the state or federal courts located in Contra Costa County, California. Each party hereby submits to the exclusive jurisdiction of those courts and waives any objection to venue or jurisdiction based on forum non conveniens or any other grounds.

Severability. If any portion of this clause is found to be invalid or unenforceable, the remaining portions shall remain in full force and effect.

Acknowledgment. Each Party acknowledges that it has read and fully understands the effect of this forum selection and choice-of-law provision, and that it has had the opportunity to consult with legal counsel before agreeing to these terms.