Patient Service Agreement

1. Who We Are

LATOM Wellness, PLLC is a physician-led, direct-pay telehealth practice focused on integrative wellness, health optimization, and personalized care. Services are provided by a licensed physician under the laws of the Commonwealth of Virginia and other states where the physician holds an active license.

2. Scope of Services

What we provide:

• Educational consultations and health assessments
• Personalized health optimization recommendations
• Laboratory testing coordination and interpretation
• Ongoing monitoring and follow-up care for established patients

3. What We Are Not

• Not a substitute for primary care or your existing physician relationship
• Not an emergency or urgent care provider
• Not covered by health insurance or government health programs
• Not a guarantee of any specific clinical outcome

4. Telehealth Limitations

Telehealth services are subject to state licensure rules. Care may be limited or unavailable in states where the physician is not licensed. Technology issues, connectivity problems, or clinical complexity may require an in-person visit with a local provider. You understand and accept these limitations.

5. Patient Responsibilities

By engaging with LATOM Wellness, you agree to:

• Provide accurate and complete medical history, including all medications and supplements
• Disclose any changes in your health status or new medical conditions
• Follow recommendations and dosing instructions as discussed with your physician
• Report any side effects, adverse reactions, or concerns promptly
• Attend follow-up consultations as recommended
• Communicate honestly about your goals, expectations, and ability to follow protocols

6. Financial Terms

LATOM Wellness is a direct-pay practice. Consultations, lab fees, and any recommended therapies are paid out of pocket. Insurance is not billed, and you are responsible for all costs. Payment is by credit or debit card via our secure checkout. Refund policies are reviewed at the time of booking.

7. No Guarantees

Individual responses to health optimization protocols vary widely. Results depend on multiple factors including overall health, genetics, lifestyle, compliance, and clinical context. The physician makes no warranty of cure or specific outcome.

8. Separate Informed Consent for Specific Therapies

If a specific therapy is recommended during your consultation, that therapy will require its own detailed informed consent, reviewed and signed with your physician at that time. This Service Agreement does not substitute for therapy-specific informed consent.

9. Emergency Care

LATOM Wellness does not provide emergency care. In the event of a medical emergency, call 911 or go to the nearest emergency department. Inform emergency providers of all therapies and medications. The physician is not available for urgent or emergency triage outside of scheduled consultations.

10. Dispute Resolution

Any dispute arising out of or relating to services provided by LATOM Wellness will be resolved exclusively by binding arbitration administered by the American Arbitration Association under the AAA Healthcare Payor Provider Rules. Arbitration will be conducted in Henrico County, Virginia. You and LATOM Wellness waive any right to a jury trial and to participate in any class action. This clause does not limit your right to file complaints with state medical boards or other regulatory bodies.

11. Governing Law

This Agreement is governed by the laws of the Commonwealth of Virginia, without regard to conflict of law principles. Exclusive jurisdiction for any matter not subject to arbitration rests in the state or federal courts located in Henrico County, Virginia.