APPOINTMENTS: Your first consultation will be scheduled for 60 minutes. For more chronic or complicated problems, the first consultation may be up to 90 minutes.

CONSULTATION FEES: Payment is expected at the time of the visit. Health insurance reimbursement forms will be given to submit to your insurance company at the end of the visit. For Phone or Zoom consults, payment will be charged on the day of the visit.

Consults: $280 for 1 hour, $420 for 1½ hours

CANCELLATION POLICY: Cancellation fee if less than 24 hours before time of scheduled visit: $100

PHONE CALLS/PHONE CONSULTATIONS: Questions that can be answered within 10 minutes will not be charged. For lengthier concerns, laboratory results, or follow-up visits: phone calls will be charged as a consult.

Dr. Debby’s practice is a consult only practice for chronic health conditions. Because of this, she does not do primary care, emergency visits, or emergency phone calls. Patients need to have a primary care physician for primary care and emergency visits and phone calls.

Acknowledgement of the Use of an Integrative Approach to Medical Care

This document is a binding contract setting forth the obligations I assume in consideration for the medical care and treatment to be provided to me. I as the patient or parent/legal caregiver agree to be bound by its terms.

I have specifically sought out the services and perspective of the providers at Holistic Pediatric Consulting for their integrative approach to medicine, drawing on Traditional and Holistic/Integrative Medicine methods. I have sought out my provider because I know that she is knowledgeable in both conventional and unconventional methods of treating illnesses and draws upon this experience and expertise to individualize and customize a treatment plan for each patient depending on the presentation. I understand that I will be presented with treatment options that include traditional and integrative approaches, and that ultimately, I will make the final decision on which method of treatment is right for me and my family.

Testing and/or treatments that may be offered or recommended by your provider at Holistic Pediatric Consulting may include, but are not limited to: Personalized Nutritional Support and/or testing, Allergy testing,, Detoxification evaluation and support, Vitamin and Mineral supplementation, Herbal Therapy, Essential Oil Therapy, Comprehensive Stool Analysis, General Laboratory Screening, Organic Acid Testing, Infectious disease testing and treatment

I have read this form that serves as an informed consent document and an authorization and have been given the opportunity to ask questions. If I have questions later, I understand I can contact a provider at Holistic Pediatric Consulting. I will be given a signed copy of this document for my records.

BY COMPLETING AND SUBMITTING THIS FORM, I AGREE THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE INFORMATION, THE ELEMENTS OF MY INFORMED CONSENT, MY RIGHTS AND RESPONSIBILITIES, AND HEREBY GIVE CONSENT TO UNDERGO TREATMENT AT HOLISTIC PEDIATRIC CONSULTING.