I specialize in the treatment of chronic illness, metabolic and nutritional disorders, the Walsh Protocol for mental health, gastrointestinal health, hormone imbalances, and more. Contact my office today to set up a consultation.
Please download the packet below. Fill out the Patient Intake Form and Patient Agreement and bring them with you to your appointment.
This is a strictly fragrance free office. Many of my patients are chemically sensitive and cannot tolerate artificial scents such as perfumes, deodorants, fabric softeners, shampoos, cigarette odor, essential oils, lotions, etc. Thank you for your cooperation in maintaining our fragrance free environment to protect them.
Please call my office at least 24 hours prior to a scheduled appointment if you need to make a change or cancel your appointment.
New patients who to fail to call at least 24 hours prior to their first appointment to reschedule and/or do not show up for the appointment will be charged the full amount of the appointment time that was held for them.
For all follow-up visits that are cancelled less than 24 hours before the appointment time and/or do not show up for the appointment, a $75 charge will be incurred regardless of the length of time originally scheduled.
For IVs or Injections that are cancelled less than 24 hours beforehand or missed outright, the charge incurred will be 50% of the original price of the missed treatment.
Policies and pricing are subject to change and notices will be posted in the office.
I do not treat patients for primary care, but will refer you to a provider of your choice.
As a patient, you are required to show proof of identity (e.g. Driver’s License, Passport, etc.).
As a healthcare provider, I am dedicated to giving you the finest care that I believe can bring you the best treatment results. In return, I ask patients to show a strong sense of responsibility for their own health and wellbeing.
As a patient, you agree to:
ask questions when you don’t understand any part of your medical care;
cooperate with the agreed upon treatment plan, or explain why cooperation is not possible;
keep scheduled appointments, or call to cancel on time (see cancellation policy);
update personal and medical information with each visit, such as change of address and other contact information, name, pregnancy, new medications and supplements and medical conditions, whenever there is a change.
We may contact you regarding appointments, test results and other matters related to your healthcare at any of the addresses, fax and/or phone numbers that you have provided on the Patient Registration Form. My intention is to respond to all patient inquiries. If you have left a phone message, sent a fax, or mailed an inquiry and have not received a response in a reasonable amount of time, you agree to call my office to make sure that we know you need to reach me. Please give all calls, emails and requests 5 office days (Tues, Wed, Thurs, except for holidays) to respond. We are a busy office with limited hours and may not be able to get to your call/request sooner. This includes but is not limited to medication requests, records requests or general questions. If you need to come pick up anything (an order, supplements, test kit, etc), please call ahead to make sure someone will be available in the office.
You may communicate with my office about medical issues by phone, fax, or mail only. We do not use email for medical information or consults as our email is not HIPAA compliant at this time.
As a patient, you agree to actively participate and communicate with this office 10 working days after you have completed a lab or other diagnostic test. We encourage this to ensure that we have indeed received your test results. Test results will be discussed with you in person during an appointment only, unless results require an emergency phone visit. The charge for a phone visit is the same as for an office visit.
If we receive abnormal test results ordered by another provider, that provider would counsel you directly about those results. However, you may request additional counseling from me by scheduling an office visit.
Lab testing will most likely be needed in order to treat you. Although we have opted out of insurance, if you have a PPO plan your general labs (or bloodwork) should continue to be covered by your insurance carrier. However, it is always a good idea to check with your insurance to ensure there are no surprises.
This also holds true for regular Medicare and Medicaid Patients. Medicare Advantage plans and HMOs may not cover your labs. For these patients, and for those with high deductibles or for those patients who do not have insurance, we offer some testing at discounted rates through Lab Corp and Ulta Labs. Our main focus and priority is serving our patients to the best of our ability and to do so at reasonable prices. We are continually striving to meet patient needs and will continue to work with labs to get the best pricing available. As an example of what we have been able to negotiate: a Whole Blood Histamine Test through Lab Corp (through Insurance) runs approximately $300+. We can offer that same test through our office for $68. Please note that some specialty labs may not be covered at all by any insurance.
Any patient under 18 years of age must be accompanied by a parent or legal guardian during each visit. Proof of identity should be provided at the time of the first visit (School ID, Birth Certificate, etc.). If the patient is a minor or legally incapacitated, the parent or legal guardian agrees that he/she has the legal authority to authorize Forouz Jowkar, PA-C to treat the patient.
As a patient, you are responsible to inform me at every visit of any change in medications or supplements that you decided to implement without my consult. Your medication renewal is subject to my periodic review of your health status to assess need and to monitor therapy.
As a patient, you must legally maintain your status as an “active” patient (in order to be eligible for any prescription renewals) by visiting my office in person at least once a year. You agree to promptly make a follow-up office visit when you are notified of this requirement prior to annual renewal of your prescription(s). If you need a prescription, please ensure that you request this and give me at least 5 office days to respond. Please note that if I am out of town, there may be an additional delay so monitor your medications closely.
In compliance with the Health Insurance Portability and Accountability Act (HIPPA) and Health and Human Services Regulations – effective April 21, 2003 – this notice describes how medical information about you may be used, how it may be disclosed, and how you may get access to this information.
Medical information about you is collected and stored as needed for treatment in the form of a personal history, treatment plan, treatment plan reviews, and progress notes on each session. This information is considered Protected Health Information or PHI. If you pay by insurance or other third party, I am often required to report your current diagnosis and progress in treatment. This report is either made by postal mail, fax or electronic mail. You are entitled to know the specific information your insurance company or other third party requires, and may request a copy of it at any time.
Disclosure of your PHI will only be made with your prior written authorization and consent. Please note these exceptions:
According to New Mexico state law, I am required to disclose your PHI in the event you are a danger to yourself or others or if you are involved in or report to me the abuse or neglect of a child or elderly person.
I may be required to disclose your PHI for reasons of national security.
I may be required to disclose your PHI if I receive a subpoena.
You may revoke your authorization, in writing, at any time.
Your Rights With Regard to Your Personal Health Information:
You have the right to request restrictions on certain uses and disclosures of your PHI. Your request will be honored whenever possible. Any denial of your request will be discussed with you.
You have the right to amend your PHI.
You have the right to receive an accounting of disclosures of your PHI when it is released for reasons other than treatment, payment and healthcare operations.
You have the right to receive a paper copy of this notice.
If you have any complaint with how your PHI has been handled, or if you believe your privacy rights have been violated, you may speak directly with me, or you may file a complaint with the Secretary of the U.S. Department of Health and Human Services. Your care will not be limited and action will not be taken against you if you file a complaint.
Your Rights With Regard to Your Personal Health Information:
I am required by law to protect the privacy of your individually identifiable health information, and to provide you with this notice.
I am required to abide by the terms of this notice.
In the event that my privacy practices or duties change, I am required to advise you of any changes in writing.