Non Members

The patient acknowledges that the visit listed above is provided as a single, isolated encounter and is not part of an active Direct Primary Care membership or ongoing care agreement.

The patient understands that:

• The visit addresses a specific concern at a single point in time.
• The visit does not establish longitudinal care, continuous access, or ongoing physician–patient relationship beyond this encounter.
• Follow-up visits, prescription refills, care coordination, laboratory monitoring, and electronic communication are not included unless the patient enrolls in a      Direct Primary Care membership.

Not Chronic Disease Management

The patient acknowledges that this isolated DPC visit:

• Is not intended to provide ongoing management of chronic, complex, or long-term medical conditions.
• Does not replace comprehensive primary care, preventive care, or specialty care.
• May involve limited review of outside records, prior laboratory results, or historical data.

Examples of conditions requiring ongoing care include, but are not limited to: diabetes, hypertension, obesity, cardiovascular disease, asthma, mental health conditions, autoimmune disorders, and other chronic illnesses.

Patient Responsibility for Ongoing Care

The patient understands and agrees that they are responsible for:

• Maintaining an ongoing relationship with a primary care provider and/or appropriate specialist.
• Obtaining appropriate follow-up,  monitoring, medication management, and preventive services outside of this isolated visit.
• Notifying the practice if they wish to establish ongoing care, which requires a separate Direct Primary Care membership agreement.

No Membership or Continuity Implied

Payment for this visit does not constitute enrollment in the Direct Primary Care practice and does not guarantee future access, availability, or continuity of care.

Patient Understanding and Consent

The patient affirms that they have had the opportunity to ask questions, understand the limitations of this isolated DPC visit, and agree to the terms outlined above.

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