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MEDICAL CONSULTATION CONTRACT
(Informational Purposes Only)

MEDICAL INFORMATION CONSULTING SERVICE
This Website offers you the unique service of the Wellness MD on the Web. Now YOU have the ability to schedule time to discuss a health related topic with a healthcare professional in the convenience and privacy of your own home. Anyone may discuss the theoretical management of their hormone imbalances by personal and confidential telephone consultation.

Consultations are ONLY on a theoretical basis, and the responses are not to be considered diagnostic or therapeutic. (No Diagnosis or Treatment can be conducted by Internet alone.) Please consult your own doctor for information specific to your case. Consultation with the WELLNESS MD on the WEB or by phone does not constitute the creation of a Physician-Patient relationship. No one under the age of 18 will be granted a phone consultation! (Proof of age is required!) Prescriptions may be provided by your own personal physician, or by Dr. A. Kryger, MD, DMD, if he becomes your physician. Appointments can be made with Dr. Kryger for in-office examinations for anyone able to travel to his office in Monterey, California. ** CALIFORNIA LAW REQUIRES AN IN-OFFICE EXAMINATION BEFORE TESTOSTERONE SUPPLEMENTS OR ANY OTHER MEDICATION CAN BE PRESCRIBED. ** IN NO CASE DOES DR. KRYGER ISSUE PRESCRIPTIONS OF ANY KIND ON THE BASIS OF A TELEPHONE CONSULTATION ONLY. A PHYSICAL EXAMINATION IS REQUIRED FOR ANY PRESCRIPTIONS TO BE ISSUED IN THE STATE OF CALIFORNIA.

Any personal information gathered at this site is kept confidential and is not sold nor given to any third parties, or released in any manner.

Initial phone consultation (personal and confidential)
SERVICE FEES (Phone consultations Include interpretation of saliva test results OR the discussion of any health related concerns.)  
Initial phone consultation (personal and confidential)
$99.00  for first 15 Minutes (interpretation of hormone tests)
$35.00  for each additional 10 minutes
$75.00  CONSULTATION WITHOUT SALIVA TEST KIT
Saliva Hormone Test Kit
$100.00  Recommended if no other up-to-date lab results are available. Hormones tested include DHEA, PROGESTERONE, TESTOSTERONE, ESTRONE, ANDROSTENEDIONE and DHT or DIHYDROTESTOSTERONE. Normal ranges for different ages included. ( please include your age) .
 INCLUDED IN PACKAGE FOR $199.00
 PLEASE SCROLL DOWN FOR CONSULTATION.
CONSULTING WITH Wellness MD
1. 
Read all the information on this page, contact us if you have questions.
2. 
Print out this page, complete the Consultation Contract portion, and fax it to (831) 373-4481
3. 
Order Saliva hormone test kit -required in advance of phone consultation.
4. 
  Note: Please wait at least 14 days for our office to receive your saliva test results from the laboratory.
Please note:
1. 
Your Initial personal and confidential Phone Consultation with Dr. Kryger will be conducted at a pre-scheduled time and will consist of 15 minutes of personal phone consultation with the Wellness MD. Before you call to set up your appointment, you must Read and Complete the Consultation Contract between you and the Wellness MD.
2. 
Call the Wellness Clinic at: (831) 373-4406. We are open Monday/Tuesday, Thursday/Friday from 9:30 AM to 3:00 PM (PST). Closed Wednesdays and weekends. If the lines are busy, please leave your name and phone number, including area code! on our answering service. Please speak slowly and clearly. You will be contacted as soon as your information has been received and your credit card has been processed.
3. 
If you ordered a Saliva Hormone Test Kit, your consultation will only relate to your hormone test results. Please call our office for full details. You may have a consultation only without hormone testing if you can fax your hormone results from prior testing.
4. 
Follow-Up Phone Consultation: If you wish to schedule a Follow-Up personal and confidential Phone Consultation, your Laboratory Tests must be received in advance. Your test results from the lab will be sent to the office of the Wellness MD. You will be notified by e-mail that your tests have arrived. After your consult is completed, you may request a copy of your lab results be sent to your physician by e-mail or Fax.
5. 
Credit Cards or Money Orders are the only accepted method of payment for Consultation Time. We do not accept debit cards or 2nd-party charges. The person using this service must be the person listed on the card.
6. 
NO appointments for consultation will be scheduled until AFTER we have received your signed CONSULTATION CONTRACT and information.
CONSULTATION CONTRACT
Name
Date of Birth
Phone Number
Email Address
I, the undersigned subscriber, request that the WELLNESS MD on the WEB reserves time for a 15-minute Initial personal and confidential Phone Consultation. I understand that the fee for this Initial Consultation is $99.00
A brief description of your Health Concerns / Topics of Interest:
Please fill out the following if you want to order the Salvia Test Kit for $99.00
Shipping Address
City/State
Zip Code
PAYMENT
Credit Cards or your health insurance are the only accepted method of payment for Consultation. Payment is made on WellnessMD secured Web Site Store. Wellness MD does not accept 2nd-party charges. The person using this service must be the person listed on the card. YOU WILL NOT BE BILLED UNTIL THE TIME OF YOUR CALL. SALIVA TESTS, IF REQUESTED, ARE BILLED TO YOUR CREDIT CARD when mailed to you.
MEDICAL CONSULTATION AGREEMENT (For Informational Purposes Only)
I understand that by signing this contract, I am bound to pay for informational consultation services only, and will so do and submit to the jurisdiction of the State of California where the information is disseminated. I have supplied a true photo identification of myself, a copy of my own credit card for payment, and my signature below. I understand that discussion of medical information does not create a physician-patient relationship because there is no material discussed identifiable or pertinent to any one individual and the data given and provided is not intended for diagnosing any condition or prescribing treatment as to a specific person, but is informational in nature only. I understand that any information given does not suggest nor dictate an exclusive course of treatment, diagnosis or procedure to be followed, and should be construed only as informational and not to exclude other methods of medical practice. I understand that this block of time for informational consultation is made available by WELLNESS MD on the WEB to me at my request. I understand that any personal information gathered at this site is kept confidential and is not sold nor given to any third parties. Should a discrepancy exist as to billable time of the time block, the long-distance telephone carrier's statement will constitute the time acceptable to both parties, and the subscriber irrevocably authorizes WELLNESS MD on the WEB access to carrier records in regard to the subscriber. If I am not satisfied with the content of the time block, I will address my concerns in writing to WELLNESS MD on the WEB, 1084 Cass Street, Monterey, CA, 93940. All disputes will be handled between WELLNESS MD on the WEB and myself by arbitration. This contract may only be enforced against all persons and entities associated with WELLNESS MD on the WEB in the State of California, County of Monterey, and under the internal laws of the State of California. This constitutes the complete contract between myself and WELLNESS MD on the WEB for personal and confidential telephone consultation only. I have read and understand in its entirety this contract between the WELLNESS MD on the WEB and myself, the subscriber. I attest that I am at least 18 years of age.
Subscriber Signature
 
Date Signed


Please print out this contract, fill out the form and fax all pages, together with a copy of your driver's license (age verification) to WELLNESS MD on the WEB at (831) 373-4481.
Your information will be kept confidential.

 
  Dr. Abraham Kryger, MD, DMD
1084 Cass Street 
Monterey, CA 93940
tel: (831) 373-4406      
fax: (831) 373-4481
Email: DrK@wellnessmd.com                                                                close window