Become a Patient

“OK. Let’s do this!”

Filling out these forms and scheduling an appointment are the only steps left to what will lead you to Vitality Health & Wellness.  All forms need to be completed either digitally or in print and received prior to being seen.   Please keep a copy of the filled out form for your records. In all likelihood, we will contact you once we receive your forms; however, don’t hesitate to call us at  (305) 466-1100 and we will give you the answer to any questions you still have and schedule you at a time that works for you. We are looking forward to being of service.

1. Click on the button below and fill out our Registration, HIPPA Release Form and Credit Card Authorization Forms. All three are required.

On-line Registration Form HIPPA Release Form Credit Card Authorization Form

All three need to be filled out.

2. Bring or email your current medications and supplements or a digital image of the bottle’s nutritional deck / label. You can also make a list which should include the quantity of supplement (# of pills per day) and amounts of ingredients contained in it (just the brand name is not helpful) – when making this list please don’t put in numbers or “bullets”. The list should read: name of supplement, strength, number of times per day (e.g. Zinc Citrate 25mg twice daily).

3. Bring, fax or email lab tests done by other physicians. Though we may choose to do labs again, having a baseline and some data on your biochemistry to pair with your story will help make the right diagnosis and come up with the correct treatments.
You can upload them here as well.

Upload files

4. Upload a picture of yourself (or your child) or email it to [email protected] with your first and last name in the subject heading; this is so that we have a “face attached to a voice” when speaking to you by phone.

Upload image

Insurance and Financial Arrangements:

Our comprehensive approach and the type of care we provide is different and thus requires more time and attention than what you would receive in a more mainstream setting.  The intensity of the time involved precludes us from accepting third party insurance.  We realize that this may be  frustrating; but it is difficult to get world class care at discounted insurance based pricing.  We truly believe this is the best investment  that you can make to move toward recovery and to prevent illness in the first place.  To make the process easier:

  • We will provide you with bills that should be acceptable to your insurance carrier so you can be reimbursed directly if you are eligible.
  • We will utilize your insurance for in-network lab testing, such as Quest Diagnostics and Labcorp, which in most cases will result in no out of pocket expense (based upon your policy).  However, there may be tests that are not be available through your “in-network” lab provider that you and the doctor decide are required to determine the best treatment plan. In that case, there will be expenses associated with those tests.  The decision to use these tests and the expense associated with them will be discussed in advance so there are no surprises and you can plan accordingly.

Payment:

Payment is required when your initial appointment is confirmed unless other arrangements have been made with us.  For your convenience we accept Visa, MC, AMEX, cash and checks.

Cancellation Policy:

We are a small office and on average see half a dozen patients a day and don’t double book our patients to keep our schedule full. A last minute cancellation is almost impossible for us to fill from our waiting list, therefore we have a 24-hour cancellation/rescheduling policy,  that it is strictly enforced. The time window for 24 hours is “Business Hours” and does not include weekends or holidays (i.e. an appointment that is scheduled for Monday morning at 10 am must be canceled or rescheduled by 10 am on Friday morning in order to avoid a charge). This is so that we have enough time during our normal business hours to connect with another patient who can make use of your slot if you can’t make it. As you know, this is standard practice even for your gym class. Cancellation fees will be based upon the full amount of time that is scheduled for the office visit. The office will attempt to contact you as a courtesy prior to your scheduled appointment time as a reminder. Please be aware that when you reschedule your appointment if you weren’t able to give us adequate notice, there will still be a charge for that new appointment and the missed / cancellation within 24 hours fee does not get applied to the next appointment with the doctor. For our lab, missed visits incur a $50 charge provided no medications have been wasted.

Other Clinicians Involved in Your Care:

If you are currently working with a primary care physician or specialist that you are comfortable with for some aspects of your medical care, we are happy to work in conjunction with them to any degree that you wish. We are here to serve you.

Registration Forms

To make the most of your first visit please print and fill out all of the mandatory forms and any optional forms then fax to 305-466-1160. Alternatively, you can mail the forms to:

Vitality Health & Wellness
801 Fourth Street
Miami Beach, Florida 33139.

Mandatory Forms if you need to print them out.  If you can’t fill out these forms on-line, you can  fill out all 4 Mandatory PDF forms below and fax them or email to [email protected] as soon as possible. 

Optional Forms