Terms & Conditions for Catalyst Transofmration 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

  • You will have two appointments with D&G Optimized Wellness and Hormones, where D&G Optimized Wellness and Hormones will review your lab results.

  • Payment for lab evaluations by Catalyst Transformations, not by you directly.

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.

Questions or Concerns?

Contact: Dr. De Leon and Dr. Rita Gillespie

info@optimizedwellness.net

863-899-2404