Letter of Understanding

Charges for Dr. Sina’s Time (i.e. office visits and phone consults)


Dr. Sina charges for all the time spent on patient care.  This includes time to review your chart and labs, writing prescriptions, researching special treatments or supplements, etc..  Therefore, the time you will be charged may be more than the time spent face-to-face with the her.


Dr. Sina has an ethical and legal responsibility to discuss the issues you bring up during your appointment.  If you have only budgeted for a certain number of minutes, it is your responsibility to bring the appointment to an end.


Prescription Medication and Refills


It is your responsibility to keep track of the number of refills you have left. No physician or pharmacy will give you reminders. Read the bottle label for the number of refills remaining and the expiration date of the prescription.  By federal law, testosterone prescriptions expire after 6 months.  Other prescriptions for sleep, anxiety, or pain may have even shorter expiration dates (some are only 30 days).


If you have no refills left on your medication prescription, it typically means that you are either due for a follow-up visit with Dr. Sina, or need to do some labs:  Your directions are outlined on your Treatment Plan. If you are unable to make an appointment or do labs if required, but need an emergency refill until you are able to come in for a visit, we can authorize and write you a one-time, Emergency Prescription Refill.


There is a $25 charge for prescriptions written outside of an office appointment. This is because it takes Dr. Sina time to review your chart and labs, and to determine if new labs are needed before the prescription can be refilled. She cannot simply ‘call in a prescription’, as most are controlled substances and it is her legal and ethical responsibility to oversee your patient care, especially in regards to prescriptive medications. Emergency Prescription Refills are for a 30 day supply of medication only, and this charge does not apply to refilling supplements in our store. If you prefer, you can have a brief appointment to obtain your refill (for more than a 30-day supply), along with the opportunity to discuss other health issues.


Bio-Identical Hormone Replacement Therapy is not standard of care medicine and requires a specialty pharmacy to fill. If you are receiving hormone replacement prescriptions for the first time, Dr. Sina generally writes them for a 60 day supply.  This is because she will need a follow-up appointment to determine whether or not your dosages need adjusting.  This fine-tuning process for hormones is more complex and challenging compared to other kinds of medications. Please note it can take 2-3 weeks to feel a response from new or revised hormone formulations. Please allow 2 weeks for medication refills to allow time for Dr. Sina to write the prescription, the pharmacy to create it, and time for mailing if applicable. PLEASE DO NOT LET YOUR MEDICATIONS RUN OUT WITHIN A 1-2 WEEK TIME PERIOD BEFORE GETTING YOUR PRESCRIPTION REAUTHORIZED. We cannot expedite the process any faster, so please plan ahead and make sure you either have your appointment set up or start the emergency refill process far enough in advance as to not run out.


Medical Malpractice


Please be aware that Dr. Sina no longer is carrying medical malpractice.  There are only two malpractice companies that cover Naturopathic Medical Doctors.  Many of the alternative medicine treatments and off-label uses of medications such as hormone therapy and chelation are no longer being covered by malpractice companies.


This form is clearly posted in our office, and as a  patient at Breakthrough Medicine you acknowledge that you understand our policies.



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