True Health Assessment Agreement-Male If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. True Health Assessment (Single payment of $400) The True Health Assessment provides a 360 degree look at the current status of your overall health and fitness. It includes a 6-part individualized nutrition and lifestyle plan for diagnostic testing, nutrition, fitness, mental health, medications and supplementation. What’s Included: Basic bio-marker testing. This lab work will be drawn by a licensed phlebotomist in our office and will be scheduled at least two weeks prior to your main office visit. The results will be discussed during your visit and are used to formulate your individualized plan. We use the answers you provide on the Functional Medicine Intake Questionnaire to determine which lab tests are most appropriate for you so make sure you complete the intake questionnaire at least 48 hrs prior to your scheduled blood draw. A complete body composition measurement done using the InBody, state of the art, body composition analyzer. InBody provides measurements of your weight, body mass index, percent muscle, percent fat, visceral fat level and body water distribution. This amount of detail allows us to better individualize your nutrition and fitness plans. A 90 minute office visit with a board certified Physician Assistant and Certified Functional Medicine Practitioner. This visit includes a thorough explanation of your lab and InBody results as well as a written comprehensive plan for nutrition, fitness and mental health. You will also be provided with recommendations for any medications or supplements or further testing we feel are indicated based on our assessment. Access to Fullscript, our online medical grade supplement dispensary. All recommended supplements are available for quick and easy purchase on Fullscript and you'll get a 10% discount on initial orders as well as refills going forward. What’s Not Included: The cost of supplements purchased through Fullscript online dispensary or other retailers. (You will however receive a 10% discount on supplements purchased through Fullscript dispensary) Laboratory test costs. As long as you provide us with your active health insurance information the lab will bill your insurance plan directly. You will not be billed for any tests that your insurance plan denies. The cost of any medications we may recommend. In addition, since we will not be providing ongoing healthcare for you, we will not prescribe any prescription medications but will only make recommendations for you to discuss with your regular healthcare provider. Notice as to Nature of Services I understand that care received at Truth & Life Nutrition Consultants Inc. may be non-traditional or unconventional. Such services are commonly referred to as complementary or alternative medicine (CAM), holistic, or innovative services. This can include nutritional and herbal consultation, including alternative approaches to hormonal difficulties, and innovative laboratory testing and diagnosis. Many of these services may not be recognized as standard medical practice, and while long practiced may still be considered investigational or experimental by the conventional medical community. Payment Payment of $400 is due in full at the submission of this agreement. I understand the details of the True Health Assessment with Truth & Life Nutrition Consultants as described above and I wish to proceed with purchase * First Name * Last Name * Address 1 * City * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State * Zip / Post Code * Phone * Email * If you are a human and are seeing this field, please leave it blank.