Please click here for a copy of our HIPAA compliant privacy practice notification.  


Thank you for scheduling an appointment with Dr. Allison Fox at Renew.  Please take a few minutes to read the information below.  You can sign the document when you come in for your appointment, or you can print, sign, and bring a copy with you.  


Dear Patient,


1.        If you have a medical emergency, call 911 or go immediately to your nearest emergency room.

2.     Dr. Fox is not providing primary care at Renew.  She is serving as an integrative and functional medicine consultant.  She is unable to provide emergency or after-hour care.  Dr. Fox requires that patients maintain their primary care physician for emergency, after-hour, and routine preventative screening tests.

3.     Once you've scheduled and confirmed your appointment, communication via Practice Fusion electronic messaging is available and recommended.  The use of secure messaging on the Practice Fusion site is to protect your personal health information from being compromised.

4.     We currently do not accept any form of health insurance or Medicare/Medicaid and are considered out-of-network.  A visit superbill is available upon request for you to submit to your insurance company.

5.     It is the patient’s responsibility to determine what, if any, out-of-network benefits they have as part of their insurance plan.  Please be advised that under Section 1862 (a) (1) of Medicare Law, Medicare will only pay for services determined to be reasonable and necessary. 

6.     Payment for lab testing is due directly to the lab.  Dr. Fox has no financial interest in the labs used for testing.  Because some insurance companies contract directly with labs for discounted testing, Dr. Fox recommends that you contact your insurance company to discuss your coverage.

7.     Because of the complex nature of Integrative & Functional Medicine, new-patient appointments will be spent primarily obtaining medical history, reviewing records, discussing health goals, and deciding what labs, if any, are indicated.  Labs will be ordered at that visit and a follow up appointment will be scheduled at which time labs will be reviewed and clinical recommendations will be discussed in full detail.   

8.     Payment for services rendered is expected at the time of service. Schedule of fees can be found below, as well as in print in the office. 

9.     I am aware that HIPAA privacy information is available at as well as in print in the office.


Integrative & Functional Medicine Consultation:

• 60-minute new-patient appointment $250

• 60-minute follow-up appointment $150


Pediatric (under age 18) Nutrition Only Appointment:

 “Nutrition only” implies a lack of symptoms or illness (help with picky eaters, overweight, etc.)

• 60-minute new-patient appointment $150

• 60-minute follow-up appointment $150


Warm regards,


Allison Fox, M.D.


I have read the above summary regarding Renew Integrative & Functional Medicine and understand and agree with the practice policies and procedures.  By signing below, it is implied that any and all questions or concerns I have regarding the practice have been answered and addressed to my satisfaction.



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