Terms & Conditions for Catalyst Transfomration Submission
By submitting this form, you acknowledge and agree to the following:
Medical Records & HIPAA Compliance
You will be entered into D&G Optimized Wellness and Hormones' electronic medical records system (Cerbo).
Your personal and health information will be protected in accordance with HIPAA regulations.
You must complete and sign a separate HIPAA Compliance Authorization Form before services are rendered.
Lab Testing Process
D&G Optimized will generate two lab slips for you:
One at the start of the program.
A follow-up lab slip 4 months later.
You are responsible for printing your lab slip and visiting a LabCorp location to complete testing.
Appointments
As part of your program, D&G will provide two (2) lab slips—one for your initial visit and another for your 4-month follow-up. If you have any questions about your lab results, we’ll schedule a consultation appointment to review them with you. A summary of your initial lab results and a comparison with your 4-month follow-up results will be uploaded to your portal for easy access.
Consent & Authorization
By submitting this form, you authorize:
D&G Optimized Wellness and Hormones to collect, store, and analyze your lab results.
Catalyst Transformations and D&G Optimized to share necessary health information for your treatment.
Lab Results Disclosure Agreement
By submitting this form, you authorize D&G to share your lab results with Catalyst Transformations to develop and direct your personalized diet, supplement, and lifestyle program. This authorization complies with HIPAA §164.508 and may be revoked in writing, except where disclosures have already been made in reliance on this consent.
Questions or Concerns?
Contact: Dr. De Leon and Dr. Rita Gillespie
info@optimizedwellness.net
863-899-2404