How the Process Works

HOW THE PROCESS WORKS

STEP ONE:

1.  Dr. Sadaty or her staff will review your current health concerns to see if this program is suitable for you and she will make recommendations for the SPECIFIC lab tests that are appropriate for your health concerns.

2.  You then have 2 options:

a.  THRIVE program-- a complete body system evaluation that allows a broader, multi-faceted sequencing of treatment based on a comprehensive lab and questionnaire evaluation. This is the ideal program option which identifies all imbalances and allows for the development of a powerful, individualized treatment plan.

b.  THRIVE-LITE-- which is an option where lab testing is more limited, consultation time is shorter and lab work can be performed in a sequential fashion. This is a less expensive option that sequentially OVER TIME identifies the internal imbalances leading to your symptoms.

STEP TWO:

1.  You will be asked to submit paperwork regarding your health history – please have these completed and submitted to the office so that we can schedule your appointment-- 6 FORMS in all: Medical Symptoms Questionnaire, 3 day diet, nutrition and lifestyle journal, please be as complete and accurate as possible, Exercise History Questionnaire, Thrive Medical Program Questionnaire, Adrenal Questionnaire, Case Review Paperwork

2.  Once you have completed your lab tests and submitted above paperwork, we will schedule the consultation appointment to explain the meaning of your test results and Dr. Sadaty will provide an individualized therapeutic program for you including diet changes, nutritional supplements, and exercise, lifestyle and stress management advice.

STEP THREE:

Subsequent consults are scheduled to monitor your progress. This varies according to your individual situation.

We invite you to contact us via the secure patient portal, MRA or phone should you have any questions during the course of your treatment. We may be reached at 516.466.0778. The staff can assist you in setting up the secure email patient portal for communication via email.

We look forward to assisting you in achieving your current wellness goals, and to guiding you in maintaining wellness throughout your life.

In health,

Dr. Sadaty and Staff

POLICIES AND PROCEDURES

Fee Schedule

Lab Consultation fee ($30 per lab test reviewed and interpreted)

Cost of Labs ordered (varies depending on the test required and your insurance coverage)

Initial Patient consultation: (60-90minutes – depending on the complexity of your situation and results of the testing). Follow up consultations are based on time required to review your case. Time is prorated beyond 60 minutes.

1 hour: $500

45 minutes: $450

30 minutes: $300

15 minutes: $150

f  Payment is due at time of consultation

f  Methods of payment are: Check, Cash, Visa, MasterCard or American Express.

f  All consultations are timed from the time the appointment begins; you will only be billed for the actual time used.

Appointments

f  Follow-up consults may be scheduled in 15, 30, 45, or 60-minute blocks of time.

f  We encourage you to book your appointments in advance.

Lab Tests

f  The results of your lab test(s) will be sent to Dr. Sadaty 2 to 4 weeks after mailing your specimens to the lab.

f  Please be sure to contact the company directly prior to mailing your samples to be clear on what your financial responsibility will be and avoid any problems AFTER they have processed your lab tests. Some testing is covered by insurance and some is not depending on the company and your insurance coverage policy.

f 

ONCE WE HAVE RECEIVED the completed QUESTIONAIRE and after evaluating the lab test results, you will be contacted to schedule your THRIVE appointment.

Cancellations

f  If you are unable to keep your scheduled appointment, you must notify our office a minimum of 24 hours before your scheduled time or you will be charged for appt.

Important Notes

f  Thrive Medical Wellness Program is not an insurance based program. It is considered a high level, health and wellness optimization program using the Functional Medicine paradigm and cannot be submitted for insurance reimbursement.

f  Laboratory fees may or may not be covered by your insurance carrier. This will be discussed with you at the time that you receive your lab kits.

f  Blood work ordered by our office is generally a covered medical expense but is dependent on your personal insurance carrier’s specific benefits and coverage.

f  Please contact the office if you are unclear about any of the policies and procedures outlined in this document

I ______(please print your name) have read and understood the above referenced Policies and Procedures.

Date______

Signature______

I clearly understand and agree that all services rendered to me are charged directly to me and that I am responsible for payment. I also understand that if I suspend or terminate my care and treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient’s Signature______Date: ______

Name: / Date:
Address: / Country:
City: / State: / Zip/Postal Code:
Home Phone: / Work Phone: / Fax:
E-mail: / Cell Phone:
Please mark your preference for occasional follow up communication from our office: _____Email _____Phone
Age: / Birth date: / Sex: M F / Status: M S W D / No. Children:
Occupation: / Employer: / Years Employed:
Spouse’s Name: / Occupation: / Employer:
Person responsible for this account: / Referred by:
What is your major concern?
Other health concerns?
What are your overall health goals once your complaints are resolved?
How long has it been since you really felt good?

PLEASE ANSWER ALL QUESTIONS FRANKLY, COMPLETELY AND TO THE BEST OF YOUR ABILITY

WEIGHT ______HEIGHT ______BLOOD PRESSURE IF KNOWN ______

ARE YOU PRESENTLY TAKING ANY MEDICATIONS, VITAMINS OR SUPPLEMENTS? PLEASE LIST:

IN THE PAST HAVE YOU USED BIRTH CONTROL PILLS OR HORMONE REPLACEMENT?

CIRCLE ALL THAT APPLY. HOW LONG DID YOU USE THESE?

IN THE PAST HAVE YOU USED ANTIBIOTICS? IF SO FOR WHAT CONDITIONS AND HOW LONG?

WERE YOU BORN BY: C-SECTION VAGINAL DELIVERY DON’T KNOW

WERE YOU BREAST-FED? YES NO DON’T KNOW

DID YOU HAVE FREQUENT INFECTIONS AS A CHILD? (CIRCLE ALL THAT APPLY)

Ear infection Sinus infection Strep Throat Eczema Food Allergies Asthma Tonsillitis

DO YOU HAVE MERCURY FILLINGS? YES NO

DO YOU PRESENTLY HAVE ANY OF THE FOLLOWING MEDICAL CONDITIONS? (CIRCLE ALL THAT APPLY)

Anemia / Frequent Headaches / Skin condition
Arthritis / Heartburn / Thyroid condition
Asthma / High blood pressure / Unexplained weight change
Chest pains / High cholesterol / PMS Endometriosis Fibroids
Chronic cold/flu symptoms / Hypoglycemia (low sugar) / Infertility Recurrent Miscarriages
Chronic fatigue / Kidney problems / Breast disease Breast Cancer Fibroadenomas Breast biopsies
Depression / Liver problems / Painful periods Heavy Periods
Diabetes / Osteoporosis / Menopause Vaginal dryness Painful intercourse Low Libido

HOW MANY HOURS DO YOU SLEEP A NIGHT ON AVERAGE?

A. WHAT IS YOUR USUAL BEDTIME?

B. HOW WOULD YOU DESCRIBE YOUR SLEEP? GREAT DISRUPTED OKAY

DO YOU HAVE ANY FOOD ALLERGIES OR SENSITIVIES? IF SO WHICH ONES?

DO YOU SMOKE, DRINK ALCOHOL OR USE RECREATIONAL DRUGS (CIRCLE ALL THAT APPLY)

A. HOW MUCH AND HOW OFTEN?

B. HOW OFTEN DO YOU DRINK CAFFEINATED BEVERAGES?

PLEASE LIST FOODS YOU TEND TO OVEREAT OR CRAVE: SWEETS BREADS FATTY FOODS MEAT DAIRY SUGAR CHOCOLATE

WRITE BRIEFLY ABOUT OUR WEIGHT GAIN/LOSS HISTORY

A. What do you feel triggered your weight fluctuation? (Circle) heredity stress eating habits boredom

B. Was your weight gain/loss: (circle) sudden gradual problem since childhood

FAMILY HISTORY OF ANY OF THE FOLLOWING: DIABETES HEART DISEASE AUTOIMMUNE DISEASE OBESITY CANCER : IF SO WHICH ONE?

WHAT METHODS HAVE YOU TRIED TO LOSE/GAIN WEIGHT

HOW IS YOUR ENERGY LEVEL ON A SCALE OF 1 TO 10

Are there times in the day that you feel best? Worst?

Are you happy in your life right now? Why or Why not?

WHAT ARE YOUR MAIN SOURCES OF STRESS?

HOW DO YOU DEAL WITH YOUR STRESS?

PLEASE ANSWER THE FOLLOWING QUESTIONS YES OR NO:

a. If I’m feeling down, a snack makes me feel better. Yes_____ No_____

b. I sometimes have a hard time going to sleep without a bedtime snack. Yes_____ No _____

c. I get tired and/or hungry in the mid-afternoon. Yes_____ No_____

d. I get a sleepy, almost “drugged” feeling after eating a meal containing bread, pasta or dessert. Yes_____ No _____

e. Now and then I think I am a secret eater. Yes _____ No_____

f. At a restaurant, I almost always eat too much bread before the meal is served. Yes_____ No_____

g. I have difficulty concentrating, or frequent fuzzy or spacey thinking patterns. Yes_____ No_____

h. I experience cravings for sugar, breads, pasta and baked goods. Yes _____ No_____

I. I feel shaky if I don’t eat on time or if I don’t snack. Yes_____ No_____

j. I often find myself irritable or angry. Yes_____ No_____

CHECK OFF ANY OF THE FOLLOWING AHT HAVE APPLIED TO YOU WITHIN THE LAST 3O DAYS

_____Do you feel nauseous? / _____Do you have abdominal/intestinal pain?
_____Do you have bloating? / _____Do you get bloated after meals?
_____Do you get heartburn? / _____Do you have diarrhea?
_____Do you have constipation? / _____Do you travel outside of the U.S.?
_____Do you have gas? / _____Are your stools compact/hard to pass?
_____Do you belch following meals? / _____Do you have gurgles in your stomach?
_____Do your bowel movements alternate between constipation and diarrhea?

SURGERIES STARTING WITH MOST RECENT (List Year and Type of Surgery and WHY)

HOSPITALIZATIONS? If so please explain when and why:

PLEASE LIST ANY COUNTRIES OUTSIDE OF THE US IN WHICH YOU HAVE TRAVELED OR LIVED

Child/Teenager:

Young Adult:

Currently:

CIRCLE “NOW” OR “PAST” FOR ONLY THOSE ITEMS WITH WHICH YOU IDENTIFY Ignore anything that does not apply to you.

Is your life: / Do you often:
Now Past Satisfactory / Now Past Feel depressed
Now Past Boring / Now Past Have anxiety
Now Past Demanding / Do you often:
Now Past Unsatisfactory / Now Past Have irrational fears
Do you worry over: / Now Past Feel upset
Now Past Home life / Now Past Feel things go wrong
Now Past Marriage / Now Past Feel shy
Now Past Children / Now Past Cry
Now Past Job / Now Past Feel inferior
Now Past Income / Now Past Money problems