There are three things you need to do to get your affordable doctor visit:
ONE: NEW PATIENTS ONLY: Send an email to AffordableFamilyClinic@yahoo.com with the following information:
- Your full name
- Your date of birth
- Your address including City, State and Zip Code
- Your phone number
- HIPAA statement: “I have recieved and read the HIPAA Privacy Statment*, understand my rights to privacy”.
- Consent statement: “I have read the Terms and Conditions*, and I consent to diagnosis and treatment by the doctor.”
TWO: Pay $27 for your visit
Call us at +1(480)357-6275 to pay with a credit card or debit card
Use your bank account to pay with Paypal
- Go to Paypal by clicking this link
- Select bank account
- Select Friends and Family option
NOTE: If you select “credit/debit card” and/or select “Goods and Services” we do not get paid for 21 days so the transaction will be cancelled.
THREE: Call Affordable Family Clinic at +1 (480) 357-6275 and talk to a live operator and tell them I am ready to speak to a doctor. (Please note that we have to have consent and payment before we notify the doctor that you are ready to do your doctor visit.)
HIPPA NOTICE OF PRIVACY PRACTICES
Effective date: 16 March 2010
We understand that health information about you and your health is personal. We are committed to protecting health information about you. We create a record of care and service you received from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice apply to all records of your care generated by this office, whether made by your personal doctor or others working in this office. This notice will tell you in ways in which we may use and disclose health information about you. We also describe your rights to health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.
We are required by law to: • Make sure that health information that indemnifies you is kept in private. • Give you this notice of our legal duties and privacy practice with respect to health information about you. • Follow the terms of Notices that is currently in effect.
How we may use and disclose health information about you: • For treatment • For payment • For health care operation • For appointment reminders • As required by Law • To avert a serious threat to health and safety • As required by the Military or Veterans and Workers Compensation • Public Health risks • Health oversight activities • Lawsuits and disputes • Law enforcement • Coroners, health examiner and funeral directors • National Security and Intelligence activities • Protective Service for the President and others • Security officials for Inmates Your rights regarding Health Information about you: • Right to inspect and copy • Right to Amend • Right to an Accounting of Disclosure • Right to request restriction • Right to request Confidential Communications • Right to a paper copy of this Notice (full Notice is available upon request)
Change to this Notice: We reserve the right to change this Notice. We will post a copy of the current notice publically with the effective date on the first page.
Complaints: If you believe that your privacy rights have been violated, you may file a complaint with us. All complaints must be in writing. Please contact us at +1 (480) 357-6275 to file a complaint.Acknowledge: We will request that you make a statement acknowledging you have received a copy of this notice. This acknowledgement will become part of your records.
CONSENT TO DIAGNOSIS AND TREATMENT
- Emergency: If this is an emergency, I will dial 9-1-1 on my telephone. Affordable Family Clinic does not provide emergency medical care.
- Payment: Payment must be made in full prior to the doctor visit. Payment is for one medical concern during a 5 minute consultation by a licensed physician. Multiple concerns require multiple doctor visits. Payment arrangements are not available. Payment for a consultation may not result in the requested prescription, and the doctor has the right to not prescribe requested medications if the medication is not indicated. Furthermore, there are conditions the doctor does not treat, and there are drugs the doctor does not prescribe. Click here for more details.
- Interpretation of Results: Results for labs and imaging require a follow up visit for interpretation. Each doctor visit is limited to one medical concern, therefore, the follow up visit for interpretation of results is limited to that task. I will make an additional appointment if I have additional medical concerns.
- Fees for Ancillary Services: As a patient of Affordable Family Clinic, I understand thatdoctor dispenses no medicine, and all prescriptions, including herbs, vitamins and nutrients, are an additional cost to the doctor visit. I understand that I am financially responsible for all fees associated with the cost of care for ancillary services such as prescriptions, labs and imaging. These fees are to be paid directly to the provider (e.g.Fry’s Pharmacy, Bashas’ Pharmacy, Theranos, AZ Tech Radiology, etc.)
- Emails: Because emails are not confidential, Affordable Family Clinic cannot discuss my medical information, nor give me a consultation by email. I will not emailAffordable Family Clinic any information regarding my health nor my medical concerns. I will not email Affordable Family Clinic any financial information such as my credit card number or bank information. I understand that Affordable Family Clinic will never ask me for health information nor financial information via email. If I am ever asked for this type of information via email, I will disregard the email and notify Affordable Family Clinic immediately. Many general questions are answered on the Affordable Family Clinic website at www.AffordableFamilyClinic.com. Specific questions or comments for the doctor can be addressed by calling Affordable Family Clinic at +1 (480) 357-6275.
- Voicemails: I understand that Affordable Family Clinic needs to speak directly to me, and it may take a minimum of 24 hours for concern left on a voice mail to be addressed. I will call +1 (480) 357-6275 until I speak to a person if I have any issues, concerns, comments or needs.
- No Mutual Exclusivity: Any treatment or advice provided to me as a patient ofAffordable Family Clinic is not mutually exclusive from any other treatment or advice that I may be receiving now or in the future, from another healthcare provider. I am at liberty to seek or continue medical care from a physician, surgeon, or other healthcare provider.
- Treatment Variance: Allopathic, Naturopathic, Homeopathic, or Chinese medical therapies provided by Affordable Family Clinic may be different from those usually offered by another licensed healthcare provider. Not all therapies are FDA approved.
- Aggravation of Symptoms: Allopathic, Naturopathic, Homeopathic, or Chinese medical treatments can lead to a temporary aggravation of symptoms. Should I experience any symptoms which I associate with natural medicines prescribed, I understand that I should promptly call Affordable Family Clinic at +1 (480) 357-6275 and continue calling until I speak to a live person.
- Side Effects: Any procedure (such as Acupuncture, Intravenous Nutrient Therapy, and Manipulation) intended to help may have side effects. While the chances of experiencing complications are small, it is the practice of Affordable Family Clinic to inform patients about them. These complications may include, but are not limited to, soreness, temporary pain or discomfort, inflammation, soft tissue injury or bruising, dizziness, and temporary worsening of symptoms. More serious complications are extremely rare. Additional information on side effects and complications is available upon request. It is also clinic policy to inform me of the procedure being performed and the risks and alternative treatments available. If my physician does not explain to my satisfaction, I will ask for more information.
- HIPPA NOTICE OF PRIVACY PRACTCES: I have read and understood the HIPPA NOTICE OF PRIVACY PRACTICES and have access to this information. I have had the opportunity to ask questions.
- Consent to Diagnosis and Treatment: By making the statement, “I consent to diagnosis and treatment by the doctor” means I have read and understand the above and have had an opportunity to ask questions. I hereby consent to treatment.