Patient Forms

Better Energy Everyday Wellness offers our practice member form(s) online in English and Español!

Click on the links below to view and print our new patient forms. Please print 6 pages total.  

Para pacientes nuevos, haga clic en los enlaces a continuación para ver e imprimir nuestros formularios.  Por favor de imprimir 6 paginas en total.

If you are having trouble viewing these forms, you may need to install Adobe Reader. Click here to install Adobe Reader.

Patient Resources

Payment Options

Better Energy Everyday Wellness is out-of-network with all insurance companies to ensure your care is between you and the doctor. Payment is due at the time of service. Cash, credit card, flex spending cards, and various electronic applications are accepted. A receipt is available upon request at time of service.

 Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for healthcare items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like diagnostic tests, supplements, equipment, and other healthcare costs.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

Payment Options

Better Energy Everyday Wellness is out-of-network with all insurance companies. This ensures your care is between you and the doctor. Payment is due at the time of service. Cash, credit card, flex spending cards, and various electronic applications are accepted. A receipt is available upon request at time of service.

 

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for healthcare items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like diagnostic tests, supplements, equipment, and other healthcare costs.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

Family Plans

Our focus at Better Energy Everyday Wellness is to actively help you and your family in taking responsibility for your health and wellness. In an effort to make living the wellness lifestyle as easy and affordable as possible, we create customized family plans that are specific to you and your family. Our goal is to have everyone in the family participating in wellness care.

 Military Appreciation Program

At Better Energy Everyday Wellness, we're committed to the care of our Active and Veteran members of the Military, and their families including Wounded Warriors & All Gold Star Dependents by providing affordable customized plans.

CONTACT US
Payments