Financial and Patient Policy

Thank you for choosing Synergy Restorative Medicine as your health service provider. Our mission is to be the industry leader in providing the Gold Standard of Care by continually delivering the highest quality patient experience.  Full financial transparency is a very important component when developing long-term relationships with our patients.  Please take a moment to review our 2019 Policies below.  The Synergy Staff is very excited to support all your service needs and we appreciate this opportunity to maximize your quality of life. 


Cancellation | No Show Policy

At Synergy, our Staff works very hard to accommodate our Patients’ scheduling needs.  The Physicians and Providers often prepare for each Patient appointments; sometime days or weeks in advance.  Out of respect for the Staff’s time (and other Patients who can benefit from the available time slot), we ask a minimum of 24-hour notice when cancelling, rescheduling, or making any changes to your appointment time slot (excluding Sundays and Mondays).  If less than 24-hour notice is given, a fee will be applied per the table below. The Physician, Provider or Office Manager will assess any assigned cancellation fees on a case-by-case basis.  Patients are then encouraged to contact the Office Staff if there are any questions or concerns with this policy.  If a fee occurs, payment will be due before scheduling the next appointment.

Late Cancellation Fee is $50

15 Minutes Late – $100 Fee and Forfeit of Appointment

No Show Fee is $100

Payment Policy

  • Payment:
    • Full payment is due at time of service.  All major credit cards, cash, checks and insurance HSA/FSA* accounts are accepted. Please note, HSA/FSA acceptance or coverage cannot be guaranteed on all services or product(s). *The insurance company could require superbills and/or medical relevance when using health savings accounts toward supplements and/or services provided at Synergy Restorative Medicine.  It is the patient’s responsibility and financial obligation to resolve issues that may arise.

    • Supplement Sales:
      • All sales on opened skin care products, supplements, UNDAs and/or botanicals are final and cannot be refunded.

      • Stem Cell Derivative Therapies:
        • All Regenerative Therapy procedures require a non-refundable $1000-$1500 deposit (depending on the treatment). Deposit is due at the time of scheduling and balance paid in full the day of treatment.

        • Outstanding Balances:
          • Any open balances not yet paid will be given a 20-day grace period.  Balances still open after 20 days will incur a 5% additional charge, added to the total, for each day the balance is outstanding.   Balances extending beyond 90 days will be subjected to collections.

          • Pro Bono Services:
            • There are unique circumstances when Synergy will provide services at extremely reduced costs.  Please contact the Synergy Staff to learn more about Pro Bono options.

            • Medical Record Fee:

                When requesting medical records for personal use, there is a $25-$75 processing fee per request and can take up to 14 business days to complete the process.

              Phone Consultations

              Established patients who are unable to come to the office in person, have the option for follow-up visits via telephone. These appointments are billed at $150 for 30 minutes. Payment is due via credit card at the beginning of each call and will be charge immediately following. 

              Email or Texting Consultations

              E-mail consultations and text messaging is discouraged by Synergy Staff due to potential HIPAA violations.  All questions pertaining to medical concerns will be redirected to make an appointment with the Physician.  If text message or emails are sent, we do not guarantee a prompt response as our Office Staff is trained to attend to in-office matters first therefore we encourage all Patients to call the office for prompt answers. Messages left for the physician will be returned with 3 business days.  Patients can utilize the email message system via patient portal (ChARM) which is HIPAA compliant.  Please note, it is the physician’s digression to answer within 5 business days or have the patient schedule an office visit. 

              Prescription Refill Policy

              If a refill of a prescription(s) is necessary, please call contact your pharmacy for refill request AT LEASE 7 DAYS PRIOR to finishing the prescription(s).  If there are no refills available, prescription(s) can take up to several days to be authorized by the Physician to be filled by the pharmacy.  Please remember that prescription renewals may require a follow up appointment with your physician so please plan accordingly.    Requests made less than 7 days in advance will be accommodated as soon as possible but may not be available due to scheduling.  In the event of a refill request less than 7 days, there may be a $50 refill request charge.  “Same Day” demands will be subjected to a $100 fee. In addition, Synergy Restorative Medicine does not provide services for “prior authorizations” on any prescription(s).

              Brilliant Distinctions and Aspire Rewards

              To support faster check-out procedures, we require all Aspire/Brilliant Distinctions Members to redeem the Reward Points prior to their appointment or walk-in hours.  Redeeming point will generate a code that is used by the front office staff to accept the reward as payment.  Without this code, points may not be able to be used as payment method.  Brilliant Distinctions will give you 100 points just for downloading the App.


              Children under the age of 16, cannot be left unattended in the wait area.  If childcare arrangements cannot be made and your child is unable to accompany you during the appointment, please call the front desk at least 24-hour prior to your appointment to reschedule.  Parents will be responsible for any damages that may occur.