Intake 2023
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Patient Authorization for Delivery of Medications

hereby acknowledge that any orders delivered damaged or incomplete must be reported to Florida Alternative Medicine; referred to as FAM within 24 hours of delivery and the pictures of damaged package / product must be sent to FAM is not financially responsible or liable for lost or stolen items once delivered. Once items have been scanned as delivered to the customer's address, it is up to the customer to report any missing or stolen packages to FAM within 24 hours of delivery date. It is up to the customer to have the FedEx Mobile App to receive step by step updates during the shipping process. Any packages returned for an INCOMPLETE/ INCORRECT address can be shipped again at the patient's expense.

No Guarantee of Services

FAM does not guarantee that any services or medications will be provided to you. Any recommended services or treatments as well as any prescriptions for medications shall be provided only after you have undergone the full initial sign-up process and examination by a licensed health care practitioner.

At the licensed health care practitioner’s discretion only, you will be prescribed medications and/or provided services during your program at Florida Alternative Medicine.

You’re required to have an annual consultation and lab work done through FAM. Lab work every 6 months is preferred but not required. Additional lab work can be requested by the provider at any time. You, as the patient, take full financial responsibility for your lab order should you decide to use your personal health insurance instead of utilizing the office cash-pay program. FAM is not liable for any future bills you may incur for said lab work if you decide to use your personal health insurance to do said labs.

No Refund Policy

FAM requires a payment of $50 at the time of scheduling a consultation. This $50 payment will be applied
towards the order total, should the licensed health care practitioner deem it medically necessary that you
begin treatment of any kind with FAM. The $50 consultation fee will only be applied to orders placed during
your scheduled consultation. The $50 consultation fee is non-refundable.

*Florida Alternative Medicine and Weight Loss LLC has a NO RETURN and NO REFUND policy.

By signing below, I understand all company policies as outlined above and agree to abide by them to their
fullest extent: