Terms and Conditions
Patient Authorization for Delivery of Medications
I, hereby authorize the clinic staff on duty to act on my behalf to accept medication delivery from the clinics dispensing physician and deliver my medications and refills to me as prescribed by my provider.
I understand that the provider is not responsible for lost or damaged goods and all issues regarding mail delivery shall be handled through the mailing company used.
I understand that I may be required to come to the office to accept delivery of such medications from the staff on duty on a weekly basis (or as often as ordered by the physician). This authorization will remain active for the course of my treatment at this clinic or until I revoke it in writing.
No Guarantee of Services
Frontline Alternative Medicine does not guarantee that any services or medications will be provided to you until you have undergone the full preliminary sign up process and physician’s examination.
At the physician’s discretion you will be provided medications and/or services during your program at Frontline Alternative Medicine.
No Refund Policy
*Frontline Alternative Medicine LLC reserves the right to have NO
RETURN and NO REFUND policy.
Informed Consent for Hormone Replacement Therapy
Because of the rapidly changing ideas about the safety and effectiveness of
hormone therapy for anything other than birth control, I feel it is important to be sure that you have information about the risks and benefits of hormone therapy before you take the therapy we have discussed. HRT is approved by the FDA for prescribed deficiencies only. Using it for other symptoms or problems is considered “off-label” use and the liability is on the patient not the doctor. When hormone levels are brought back to “normal” for your age there is much evidence that your overall health will benefit. HRT is the most effective treatment for hormone deficiencies. There may be other long-term beneficial effects of treatment. The medical frame of mind is always changing so it is important to discuss HRT with your doctor each year at your annual exam to find out what the latest information is.
Please read the following and sign: I have discussed the reason for taking female/male sex hormones with my provider. I understand why he/she is prescribing them and the risks associated with taking hormones including but not limited to the possibility of an increased risk of breast or endometrial cancer, blood clotting, stroke, or heart attack. I understand that there are different risks if I take any HRT medication. I have discussed these risks and the reasons for taking them, with my doctor. I understand that my provider will do everything he/she knows to do to decrease and minimize the risks of
HRT. I understand that there are no guarantees that these measures will be effective at preventing the negative side effects mentioned above or others that we do not yet know about. I accept the risks and unknowns of taking hormone therapy and wish to have my provider prescribe them for me.
If you have any questions or concerns about this Agreement, please contact us by email at firstname.lastname@example.org.We will attempt to respond to your questions or concerns promptly after we receive them.
Last Updated: December 04, 2019.