Dear Patient:

We would like to introduce you to The Itasca Plan; a way to make naturopathic healthcare expenses easier to manage. Under the plan, patients receive lower, fixed rates for office visits and BIA (Bio Impedance Analysis) tests. The details of the plan are as follows:

  • The cost of the six-month program is $150 (payment plan available)
  • Appointments are discounted by 33%.
  • BIAs, optional, are $20 (normally $25).

Under this program:

  • A new patient visit, normally $122-288, is $82-193
  • A return patient visit, normally $57-162, is $38-109

Our goals in designing this program:

  • Make it easy to join.
  • Make the terms of the commitment both reasonable and fair.
  • Structure it so that anybody can see a real benefit.

FAQs

When can I join?

You may join at any time. Most people join at the time of an office visit. Individual family

members can join at different times.

What happens at the end of the six month period?
Your plan terminates, and you can start up again at your next appointment.

How does the payment plan option work?

The first $25 will be added to your bill the day you join; the remaining five payments of $25

are charged to a credit or debit account on your choice of the fifth, fifteenth or twenty-fifth of

each month.

Are there discounts for supplements or labwork?

No. Supplements and labwork are not affected by this program.

Are phone visits included?

Yes. As always, brief questions (less than five minutes) are not charged. All phone visits over five

minutes are billed at the discounted rates listed on the next page.

Will I benefit by signing up for this program?

The patients who benefit the most from this program are those who have two or more long visits

(60+minutes) and those who have frequent visits (one or more per month) in a six-month period of

time. Dr. Oppitz and the receptionist can help you determine the best rate schedule for your

situation.

Additional questions can be addressed to Dr. Oppitzor by INC’s clinic administrator Chris Oppitz.

Revised 6/10/2014

The Itasca Plan Agreement

By signing this form you are stating that you understand and agree to the following:

  • The six-month program is $150.
  • If I choose the payment plan, the first installment of $25 is paid the day I join; the remaining five installments of $25 will be charged to the credit or debit card I have listed below.
  • Under this plan, office and phone visits will be billed as follows:

-Phone visits five minutes or less are not charged

-Appointments 6-10 minutes: $20.00

-Appointments 11-20 minutes: $38.00

-Appointments 21-30 minutes: $58.00

-Appointmetns 31-45 minutes: $82.00

-Appointments 46-60 minutes: $109.00

-Appointments 61-80 minutes: $137.00

-Appointments 81-100 minutes: $171.00

-Appointments 101-120 minutes: $193.00

-In addition to this, BIAs are $20.

  • Supplements, labwork, and services performed by a practitioner other than Dr. Oppitz are not affected by this plan.
  • This plan may be used only for the patient listed below and is non-transferable.

Signature: ______Date: ______

Printed: ______Phone #:______

Patient Name (if different than above): ______

------Information below necessary only for those choosing the payment plan------

Credit/Debit Card: ______-______-______-______Exp. Date:______-______

Please circle: Visa MC Discover

Monthly draw/charge date (choose one): 5th 15th 25th

------Office Use Only Below This Line------

Date Drawn: ______

Initials:

Plan Expires: ______. Expiration letter sent: ______by ______.

Revised 6/10/2014