Terms Of Use

BY ACCESSING, BROWSING AND/OR USING THE SITE, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO BE BOUND BY THESE TERMS AND CONDITIONS OF USE ("TERMS AND CONDITIONS OF USE") INCLUDING THE PRIVACY POLICY ("PRIVACY POLICY") (COLLECTIVELY THE "TERMS") AND TO COMPLY WITH ALL APPLICABLE U.S. LAWS AND REGULATIONS. In addition, you hereby represent and certify that you are at least eighteen (18) years of age. If you do not or cannot agree to the Terms, you are not authorized to use the Site or any of the services offered through the Site. MWWC reserves the right, in its sole discretion, to update, revise, supplement and to otherwise modify these Terms, and to impose new or additional terms and conditions on your use of the Site from time to time. Such updates, revisions, supplements, modifications and additional rules, policies, terms and conditions (collectively referred to in these Terms as "Additional Terms") shall be effective immediately and incorporated into these Terms upon notice thereof, which may be given by any reasonable means including by posting to the Site. Your continued viewing or use of the Site following such notice shall be deemed to conclusively indicate your acceptance of any and all such Additional Terms.

 

Acceptable Use of the Site:

In order to use the Site, you must obtain access to the Internet and pay any and all service fees associated with such access.

(a) Individual Use. You agree that you are only authorized to visit, view, print and retain a single copy of pages of the Site for your own internal use and not on behalf of any other person or entities, and that you shall not duplicate, download, publish, modify, or otherwise distribute any material on the Site for any purpose other than for your own internal use unless otherwise specifically authorized by MWWC in writing. MWWC may post legal notices and various credits on pages of the Site, which you shall not remove even in your permitted copies.

(b) Framing. You agree not to create any frames on any other web sites pertaining to or using any of the content located at the Site for any purpose, unless specifically authorized by MWWC in writing to do so.

(c) Security, Cracking, and Hacking. You are prohibited from violating or attempting to violate the security of the Site. Accordingly, you agree not to: (i) access data or materials not intended for you; (ii) log into a server or account which you are not authorized to access; (iii) attempt to probe, scan, or test the vulnerability of a system or network or to breach security or authentication measures without proper authorization; or (iv) attempt to interfere with service to any user, host, or network, including without limitation, by means of submitting a virus to the Site, overloading, "flooding", "mailbombing", or "crashing" the Site. Violations of system or network security may result in civil or criminal liability. MWWC reserves the right to investigate occurrences which may involve such violations and may involve and cooperate with law enforcement authorities in prosecuting users who have participated in such violations. You understand that data and communications, including e-mail and other electronic communications, may be accessed by unauthorized third parties when communicated over the Internet.

(d) You Are Responsible For All of Your Activities and All of The Content You Post or Submit. You represent and warrant that any information and/or material you post or provide to MWWC by means of the Site, including, without limitation, as part of any registration or subscription or to gain access to or use any services offered on the Site ("Submissions"), is truthful, accurate, not misleading, not confidential property of others, not in violation of any other third party's rights, and offered in good faith. You agree NOT to use the Site for or in connection with any of the following activities: (i) transmitting or relaying spam or other unauthorized or unsolicited communications, spoofing or otherwise impersonating any person or entity, or falsely stating or otherwise misrepresenting your identity or affiliation in any way; (ii) using the Site for any fraudulent or illegal purpose or to encourage conduct that would be considered fraudulent or illegal; (iii) e-mailing, uploading, or otherwise transmitting or using the Site in furtherance of the use, distribution, or transmission of any unlawful, harassing, defamatory, tortious, libelous, sexually explicit, obscene, hateful, racially, ethnically, or otherwise objectionable material of any kind; (iv) transmitting material that contains viruses, Trojan horses, worms, time bombs, cancelbots, or other computer programming routines or engines that are intended to damage, destroy, disrupt, or otherwise limit, interfere with, or impair a computer's functionality or the operation of the Site or surreptitiously intercept or expropriate any system, data or information related to the Site or any computer hardware, software or other equipment that is owned, leased or used by MWWC; and (v) using any robot, spider, scraper or any other automated means or device designed to provide repeated or automated access to the Site for any purpose.

(e) Information Disclosed via the Site. IN ADDITION TO ANY OTHER WARRANTY DISCLAIMER PROVIDED IN THE TERMS, ANY INFORMATION DISCLOSED TO YOU VIA THE SITE INCLUDING, WITHOUT LIMITATION, ANY CONTENT, HEALTH CARE PROFESSIONAL REFERRALS, PRODUCT RECOMMENDATIONS, PRODUCT DESCRIPTIONS, PRODUCT SAFETY AND/OR EFFECTIVENESS MATERIALS, ARE NOT OFFERED WITH ANY WARRANTY OR REPRESENTATION AS TO ABILITY, ACCURACY, PERFORMANCE, OR SUITABILITY FOR YOUR INTENDED PURPOSE OR COMPLIANCE WITH APPLICABLE LAW. MWWC ASSUMES NO RESPONSIBILITY, AND DISCLAIMS ANY LIABILITY FOR, ANY ILLNESS, OR INJURY RESULTING FROM USING ANY PRODUCTS OR FOLLOWING ANY ADVICE CONTAINED ON THIS SITE OR FOR ANY HEALTH CARE PROVIDED BY ANY HEALTH CARE PROFESSIONAL TO WHICH YOU WERE REFERRED VIA THE SITE. YOU ACKNOWLEDGE AND AGREE THAT USE OF ANY DIETARY SUPPLEMENT PRODUCTS INVOLVES UNFORESEEABLE RISKS AND UNCERTAINTIES, INCLUDING, WITHOUT LIMITATION, THE RISKS OF: (A) INDIVIDUALS' BIOLOGICAL VARIATION AND RESPONSE TO HERBAL/BOTANICAL PRODUCTS; (B) PRODUCT INTERACTIONS WITH OTHER HERBAL AND DRUG INGREDIENTS; AND (C) OTHER HEALTH RISKS AND UNCERTAINTIES. Information on the Site is provided for informational purposes only, does not constitute medical or health-related advice, and is not intended to diagnose, treat, cure or prevent any disease or health problem. Statements made on the Site have not been evaluated by the FDA.

(f) Do Not Violate Third Party Intellectual Property Rights. Without limiting the foregoing, you shall not, and by using the Site you agree not to use the Site to: (i) transmit or post any Submissions that are copyrighted, unless you are the copyright owner or have obtained the permission of the copyright owner to transmit it; (ii) transmit or post any Submissions that reveal trade secrets, unless you own them or have the permission of the owner to so transmit them; or (iii) transmit or post any Submissions that infringe on any Intellectual Property Rights (as defined below) of others or violates the privacy or rights of publicity of others. 

(g) Ownership. MWWC places content on the Site for you to examine from time to time including, without limitation, text, graphics, photographs, pictures, drawings, animation, audio, video, literature, and any other material distributed by MWWC on, through, or in connection with the Site. Moreover, MWWC attempts to display the content in a way that will be easily accessible and useful for you, the user. All content and materials on the Site including, without limitation, text, graphics, logos, button icons, images, audio clips, and software included in the Site and any services offered on the Site, are the property of MWWC, its sponsors, or business affiliates, and/or their respective licensors, and are subject to U.S. and international Intellectual Property Rights laws. The compilation of all content on the Site is the exclusive property of MWWC (unless otherwise indicated) and is protected by U.S. and international copyright and trademark laws. All software used on the Site is the property of MWWC or its licensors (or licensed by MWWC) and is subject to U.S. and international copyright laws. Except to the minimum extent otherwise expressly permitted under copyright law, no copying or exploitation of material from the Site is permitted except expressly in accordance with these Terms or with the express written permission of MWWC and any other applicable copyright owner. You acknowledge that you do not acquire any ownership rights by virtue of downloading copyrighted material from the Site. All rights not expressly granted hereunder are expressly reserved to MWWC.

 

 

Warranty Disclaimer:

THE CONTENT, SERVICES, INFORMATION, AND ACCESS TO THE SITE ARE PROVIDED "AS IS" AND "AS AVAILABLE" AND WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, SATISFACTORY QUALITY AND NONINFRINGEMENT. MWWC DOES NOT WARRANT THAT ANY PART OF THE SITE WILL OPERATE UNINTERRUPTED OR ERROR-FREE, THAT EFFECTS WILL BE CORRECTED, OR THAT THE SITE OR THE SERVER THAT MAKES IT AVAILABLE ARE FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS OR THAT TRANSMISSION TO OR FROM THE SITE AND ACCESS TO THE SITE WILL BE UNINTERRUPTED, CONTINUOUS, OR ERROR-FREE. MWWC DOES NOT WARRANT OR MAKE ANY REPRESENTATIONS REGARDING THE USE OR THE RESULTS OF THE USE OF THE SITE IN TERMS OF ITS QUALITY, CORRECTNESS, ACCURACY, RELIABILITY, OR OTHERWISE. YOU SHOULD THEREFORE VERIFY ANY INFORMATION OBTAINED FROM THIS SITE BEFORE ACTING ON IT. ANY RELIANCE ON SITE CONTENT IS AT YOUR OWN RISK. EXCEPT AS OTHERWISE EXPRESSLY PROVIDED, MWWC EXPRESSLY DISCLAIMS ANY RESPONSIBILITY FOR THE ACCURACY, CONTENT, AVAILABILITY OF INFORMATION, PRODUCTS, SERVICES, OR MERCHANDISE FOUND ON THIRD PARTY SITES THAT LINK TO OR FROM THE SITE. MWWC DISCLAIMS ANY RESPONSIBILITY FOR PRODUCT OR SERVICE ORDERING FUNCTIONS, ORDER FULFILLMENT OR COMPLIANCE OF PRODUCTS OR SERVICES WITH ANY MANUFACTURER'S WARRANTIES OR SPECIFICATIONS. MWWC CANNOT BE HELD RESPONSIBLE FOR THE MATERIAL CONTAINED ON THIRD PARTY SITES AND/OR RELATED SERVICES NOR DOES BLC MAKE ANY REPRESENTATIONS OR WARRANTIES AS TO THE SECURITY OF ANY INFORMATION YOU MIGHT BE REQUESTED TO GIVE TO THIRD PARTY SITES.

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Limitation of Liability:

YOUR USE OF THE SITE IS AT YOUR OWN RISK. TO THE FURTHEST EXTENT PERMITTED BY LAW, UNDER NO CIRCUMSTANCES INCLUDING, WITHOUT LIMITATION, MWWC NEGLIGENCE, SHALL MWWC, ITS AFFILIATES, RELATED ENTITIES, VENDORS OR CONTENT PROVIDERS (COLLECTIVELY, THE "MWWC PARTIES") BE RESPONSIBLE OR LIABLE FOR ANY DAMAGES INCLUDING, WITHOUT LIMITATION, DIRECT, SPECIAL, INDIRECT, PUNITIVE, CONSEQUENTIAL, EXEMPLARY AND/OR INCIDENTAL DAMAGES THAT RESULT FROM YOUR USE OR INABILITY TO USE THE SITE, ANY CONTENT AND/OR ANY RELATED SOFTWARE, EVEN IF MWWC OR AN AUTHORIZED MWWC REPRESENTATIVE HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. NOTWITHSTANDING ANYTHING ELSE CONTAINED IN THESE TERMS, IN THE EVENT THE TERMS OF THIS SECTION, OR ANY PART OF THIS SECTION, SHALL BE HELD INVALID OR UNENFORCEABLE BY A COURT OF COMPETENT JURISDICTION, IN NO EVENT SHALL MWWC's TOTAL LIABILITY TO YOU, OR ANYONE CLAIMING BY OR THROUGH YOU, FOR ANY DAMAGES, LOSSES, CLAIMS AND/OR CAUSES OF ACTION, WHETHER IN CONTRACT, TORT, NEGLIGENCE OR OTHERWISE EXCEED ONE HUNDRED DOLLARS ($100). IF YOU LIVE IN A STATE THAT DOES NOT ALLOW THE WAIVER OF CERTAIN WARRANTIES, OR LIABILITY LIMITATIONS OR DAMAGES WAIVERS DESCRIBED IN THIS SECTION, SOME OF THESE PROVISIONS MAY NOT APPLY TO YOU. YOU AGREE TO PROMPTLY NOTIFY MWWC IN WRITING IF YOU BELIEVE YOU HAVE ANY CLAIM AGAINST THE MWWC PARTIES, AND, IN ANY EVENT, YOU AGREE THAT ANY CLAIM NOT BROUGHT WITHIN ONE YEAR AFTER IT ARISES (OR SUCH SHORTER PERIOD UNDER APPLICABLE STATUTES OF LIMITATION) SHALL BE WAIVED AND RELEASED.

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Indemnification:

You shall indemnify, defend, and hold harmless MWWC and its sponsors, business affiliates, vendors, content providers, subsidiaries, related entities, affiliates, officers, directors, employees, attorneys, and agents, from and against any and all damages, claims, and actions brought by you or any third party resulting from (i) your use of the Site in violation of the Terms; (ii) your violation of law; or (iii) the infringement by you of any Intellectual Property Rights or any publicity, contract or privacy rights of any person or entity.

 

Termination

The Terms are effective until terminated by MWWC. MWWC may terminate, restrict, or suspend all or part of your access to the Site and delete any Submissions, at any time, in its sole discretion, without prior notice to you and without any liability to you.

 

Governing Law & Arbitration: 

The laws of the State of Illinois (excluding any principles of conflicts of laws) govern your use of the Site, the services and these Terms. You agree that the parties shall settle any claim or dispute relating to these Terms by binding arbitration in Chicago, IL under the Commercial Arbitration Rules of the American Arbitration Association. To the fullest extent permitted by applicable law, no arbitration under these Terms shall be joined to an arbitration involving any other party subject to these Terms, whether through class arbitration proceedings or otherwise. Notwithstanding the dispute resolution requirements set forth above, for any injunctive relief relating to the access to, or use of, the Site including, without limitation, related services, you agree and hereby submit to the exclusive jurisdiction and venue of the appropriate state or federal courts located in Chicago, Illinois, U.S.A.

 

Waiver & Severability:

Furthermore, no delay or omission by MWWC to exercise any right or any noncompliance on your part with respect to the Terms shall impair any such right or be construed to be a waiver by MWWC. If any provision of the Terms is found by a court of competent jurisdiction to be invalid or unenforceable in whole or in part, such provision shall, as to such jurisdiction, be ineffective to the extent of such invalidity or unenforceability without in any manner affecting the validity or enforceability thereof in any other jurisdiction or the remaining provisions hereof in any jurisdiction, provided, however, if such invalid or unenforceable provision may be modified so as to be valid and enforceable as a matter of law, such provision will be deemed to have been modified so as to be valid and enforceable to the maximum extent permitted by law.

 

Mobile Devices:

Some mobile devices may not be capable of accessing the Site in its entirety. MWWC is not responsible or liable for any errors, inaccuracies, faults, or failures arising from your attempts to access any portion of the Site using any mobile device. Furthermore, you agree that you alone are responsible for all access and connectivity charges imposed by your communications carrier in connection with your use of any mobile device.

 

Copyright Agent for Claims of Copyright Infringement:

Pursuant to the Digital Millennium Copyright Act, MWWC designates the agent below to receive notifications of claimed copyright infringement. If you reasonably believe that your work has been copied in a way that constitutes copyright infringement, you must provide to MWWC's designated agent all of the following information:

  1. an electronic or physical signature of the owner or the person authorized to act on behalf of the owner of the copyright interest;

  2. a description of the copyrighted work that you claim has been infringed;

  3. a description of where the material that you claim is infringing is located on the Site;

  4. your name, address, telephone number, and e-mail address;

  5. a statement by you that you have a good-faith belief that the disputed use is not authorized by the copyright owner, its agent, or the law; and

  6. a statement by you, made under penalty of perjury, that the information in your notification is accurate and that you are the copyright owner or authorized to act on behalf of the copyright owner.

MWWC's designated agent for notification is Anastasia Kovalaske who can be contacted here:

 

By Phone:

309-220-8472

 

By E-mail:

team@midlifewomenswellnessclinic.com

 

Contract Electronically:

You agree that the Terms, combined with your act of using the Site and/or the services offered on or through the Site have the same legal force and effect as a written contract with your written signature and satisfy any laws that require a writing or signature, including any applicable Statute of Frauds. You further agree that you shall not challenge the validity, enforceability or admissibility of the Terms on the grounds that it was electronically transmitted or authorized. In addition, you acknowledge that you have had the opportunity to print the Terms.

Entire Agreement

The Terms constitute the entire agreement between you and MWWC related to your use of the Site. Any prior agreements, representations, statements, or negotiations with respect to the subject matter of the Terms are superseded by the Terms. You have not relied on any representations that may have been made by MWWC related to the Site.

PRIVACY POLICY:

**Midlife Women’s Wellness Clinic (MWWC) SERVICES POLICIES**

Our Mission is to assist you in achieving physical, spiritual, and emotional well-being using a holistic approach to health. Our Philosophy is to educate and empower you to live in optimal wellness so you may: 


**“Elevate Your Health. Unleash Your Potential. Invest in Yourself” .**  


This approach complements any existing health care program.

Midlife Women’s Wellness Clinic (MWWC) Intent:

The intent of any and all services offered and/or nutritional protocols or lifestyle recommendations suggested the MWWC team is designed to support the natural physiological & biochemical processes of the human body. The purpose is not to diagnose, treat, prevent or cure any disease. All suggested protocols are from a holistic perspective. As such, MWWC does not act as your primary care physician and you must continue to have a medical PCP and keep them informed of all your healthcare activities.

​** Benefits of Functional Medicine and Scope of Practice: **The team at Midlife Women’s Wellness Clinic use diagnostic and treatment methods that - in addition to conventional health care - are known as preventative, complementary, alternative, functional, naturopathic, or integrative medicine (collectively, "Functional Medicine"). Functional Medicine focuses on nutritional and metabolic imbalances, diet, exercise, environmental influences, and psycho-social stressors based on the premise that they directly relate to the development and maintenance of illness. Functional Medicine evaluates these influences and then specifically tries to remedy them. It encourages patients to give up negative lifestyle patterns and establish more positive ones, regardless of the type of medical conditions for which they are seeking treatment.


I understand that, as with any health treatment, Functional Medicine is not without risk. Potential risks of treatment include, but are not limited to, allergic reactions, sensitivities, adverse effects from, or in response to, natural supplements or dietary measures, failure to improve or worsening of my condition, and difficulty adjusting to lifestyle modifications.

I agree to inform MWWC's clinical staff of all known factors that might affect treatment, including, but not limited to, all medications, drugs, drug sensitivities and allergies, history of seizures, fits or fainting, presence of a pacemaker, bleeding disorder, use of anti-coagulants, damaged heart valves or occluded vessels, immune deficiencies, or other special risks of infection, as well as any other significant factors within my knowledge. I further agree to inform MWWC's clinical staff of any disorder or state of mind that might affect my capacity to make informed health decisions, and should any such impairment exist, I will provide information regarding a surrogate decision maker.


**Consent to Participate in Telemedicine/Telehealth** By scheduling with Midlife Women’s Wellness Clinic and by signing this agreement I acknowledge that I am agreeing to participate in telemedicine/telehealth consultation with the practitioners and/or staff at MWWC. I am seeking this consultation for my own purposes and not on behalf of any third party. I understand the risks, benefits, limitations, and alternatives to tele-consults and have chosen of my own free will to participate in tele-consults with MWWC. I understand I am a participant rateolain the decision-making process, and I am free to decline any service/treatment/recommendation/suggestion offered by the MWWC practitioners at any time.  I understand that tele-consults typically involve the use of audio and/or video or other technology between me and the practitioner. Due to the nature of tele-consults, visits are largely educational and rely heavily on the patient history and laboratory findings. Exams and vital findings via video or phone are limited in nature vs an in-person examination. I agree to bring to the attention of MWWC's clinical staff, if, at any time, I have any lack of understanding of such risks, benefits, and alternatives, and inquire of clinical staff for further explanation until I have a full understanding before giving consent to any procedure or treatment.


**Scheduling: ** It is mandatory that all new patients complete their initial functional medicine intake forms and consents at least 48 hours before their scheduled appointment time. Your provider requires this information to complete your medical history review prior to your scheduled appointment. 


**Cancellations: ** We request a minimum of 48 hours advance notice for any cancellation or rescheduling of your appointment. This is a consideration for our practitioners.  Failure to notify us of your need to cancel or reschedule your appointment within 48 business hours of your scheduled appointment will result in a no-show fee. The charge for a canceled or rescheduled appointment will be 50% of the cost of the scheduled appointment.

**Payment of Services: ** Payment in full is expected at the time of scheduling or at the time of service. Midlife Women’s Wellness Clinic receives payment in credit, debit cards, also through Zelle and PayPal. There are no service refunds. You agree that your credit card on file will be automatically charged for any Midlife Women’s Wellness Clinic invoice generated such as your visit fee or if a supplement order or lab order is requested. You also authorize Midlife Women’s Wellness Clinic to automatically charge your credit card for any missed appointments or late cancellations of less than 48 hours in advance at the full-service fee. There is no charge for rescheduling or canceling appointments more than 48 hours in advance. I am also responsible for any chargeback fees if for some reason my credit card is declined. This authorization is part of my records and will be treated with privacy, confidentiality, and respect.

Additional time charge:

If a visit goes over the scheduled time (ex. 1 hour) then there will be an additional visit charge in 15 minute increments at the prorated rate. Your credit card on file will be charged after the visit is complete.


**Refunds: ** Supplements and Lab work is purchased through outside vendors and Midlife Women’s Wellness Clinic cannot issue any refunds, please only purchase items you intend to use.  At Midlife Women’s Wellness Clinic you may receive a refund for an individual service that was prepaid but not used and canceled with the 48-hour notice before the appointment. You may receive a refund for a prepaid visit if Midlife Women’s Wellness Clinic cancels the appointment and you do not wish to reschedule.
This excludes program packages agreed and purchased in advance and excludes programs purchased under a payment plan. There is no refund for program services purchased with a payment plan in which the patient decides to discontinue appointments prior to appointment(s) fulfillment or before completion of program duration. There is no refund for a purchase bought as a set of visits/services/package/program plan unless there are extenuating circumstances discussed and agreed upon with Anastasia Kovalaske, APRN, FMACP. There are no refunds for services that have already been fulfilled (ex. after a visit).

 
**Advanced Practice Registered Nurse (APRN): ** Anastasia Kovalaske is an Advanced Practice Registered Nurse and specializes in functional medicine and nutrition operating within the scope of her license. Anastasia Kovalaske, APRN does not act as a primary care physician and is not on call, nor are any the Midlife Women’s Wellness Clinic practitioners regardless of license type.   Please maintain a positive, working relationship with your medical doctor, keep him/her informed of your healing activities and continue your regular medical care and check-ups. This applies to all providers/practitioners with Midlife Women’s Wellness Clinic
**Photo release, Social Media release, Website and Marketing release** You agree to authorize Midlife Women’s Wellness Clinic use of any public reviews (ex. Google, Yelp, Facebook, etc) that you submit, or a review emailed to us. These reviews may be used for marketing activities and other online promotions via social media, websites and all printed or digital publications and media in perpetuity. You acknowledge that participation is voluntary, there is no financial compensation, and this includes photos, graphics, and testimonials. You released Midlife Women’s Wellness Clinic and 

Anastasia Kovalaske, APRN, FMACP. of any liability or claims by me or any third party related to the use of photographs, graphics or testimonials in printed or digital media. 


**Updates toMidlife Women’s Wellness Clinic Policies* graphics, updates to our Policies will be immediately applicable to you & all previous signers and posted on the Midlife Women’s Wellness Clinic website and in our Practice Better software. You may view them there or request an updated copy emailed to you at any time. 


**Stopping Medication: ** Midlife Women’s Wellness Clinic practitioners will **NOT** take you off any medication, which can only be done with your prescribing physician. If your goal is to decrease your need for medication, we can suggest a protocol to encourage health and then you may work with your primary physician to monitor your progress and see if you are able to lower or eliminate your medication dosage over time. Keep your primary physician informed. 


**Emergencies: ** In case of an emergency, call your PCP, visit your local urgent care or call 911.


INFORMED CONSENT


You may or may not be utilizing all of the services mentioned below:
 

**INFORMED CONSENT FOR FUNCTIONAL MEDICINE & NUTRITION CARE (Which includes all items mentioned above). **
To the patient (or their legal guardian, court-appointed conservator, or agent):  Please read this entire form prior to signing it.  Please ask any questions prior to signing this form if you are unclear about anything in this form.


**Other Procedures** - There are a number of other procedures used by Anastasia Kovalaske, APRN, FMACP that may be utilized.  Treatment may include physical therapy modalities (such as nutrition, health coaching & exercise recommendations, etc.). Additionally, there may be referrals to other associated practitioners in theMidlife Women’s Wellness Clinic office or outside doctors/practitioners as necessary, and their treatment should involve the same informed consent with disclosure of risks and benefits as is being done here. 


No Guarantee - Results Dependent on Consultant

We can not guarantee results but will share good practices that have been effective in our clinical experience and in practice by those we have coached and worked with over the years. It will always be incumbent on you to “do the work”, to do your research and take action steps.

 

Not Legal Advice - Not Tax Advice

Our team may share experience and practical stories based on their practice or those of clients they have coached or what is considered standard in the industry. However, we are not an attorney and none of the advice shared constitutes legal or tax advice. Please consult legal advice or tax advice when/as needed and note that the laws may different by your county, state or country and often differ by medical license.


 
HIPPA PRIVACY NOTICE
 

**HIPAA Notice of Privacy Practices**
Midlife Women’s Wellness Clinic

Anastasia Kovalaske, APRN, FMACP
 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.


In the course of your care as a patient or client with any practitioner at Midlife Women’s Wellness Clinic (MWWC), we may use or disclose personal and health-related information about you in the following ways:


-Your personal health information, including your clinical records, may be disclosed to another health care provider or hospital if it is necessary to refer you for further diagnosis, assessment, or treatment.


-Your health care records, as well as your billing records, may be disclosed to another party, such as an insurance carrier, an HMO, a PPO, or your employer if they are or may be responsible for the payment of your services.


-Your name, address, phone number, and your health care records may be used to contact you regarding appointment reminders, to provide information about alternatives to your present care, or to provide other health-related information that may be of interest to you.


-**We may also provide treatment in an “open” or “group adjusting” or "group nutrition" or "group coaching" environment where other patients may be seen and advised at the same time in close proximity to you. ** This situation would necessitate the discussion of your health, subjective symptoms/treatment, etc. in the presence of other patients. **You may always choose to exclusively participate in private appointments. ** 


You have a right to confidential communications and to request restrictions relative to such contacts.  You also have the right to be contacted by alternative means or at alternative locations.  Such requests must be made to us in writing.  Such requests are not automatic and require the agreement of this office.

If you are not at home to receive an appointment reminder, a message may be left on your answering machine or with a person in your household. 

Further, you have the right to inspect or obtain a copy of the information we will use for these purposes.  You also have the right to refuse to provide authorization for this office to contact you regarding these matters.  If you do not provide us with this authorization, it will not affect the care provided to you or the reimbursement avenues associated with your care. 

Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in the following circumstances:

-If we are providing health care services to you based on the orders of another health care provider. 
-If we provide health care services to you in an emergency.
-If we are required by law to provide care to you and we are unable to obtain your consent after attempting to do so.
-If there are substantial barriers to communicating with you, but in our professional judgment we believe that you intend for us to provide care.
-If we are ordered by the courts or another appropriate agency.

You have a right to receive an accounting of any such disclosures made by this office.  Any use or disclosure of your protected health information, other than as described in the examples outlined above, will only be made upon your written authorization.  We normally provide information about your health care to you at the time you receive health coaching, functional medicine, nutritional advice, etc from us.  We may also mail, email, or text information to you regarding your health care or about the status of your account. If you would like to receive this information at an address other than your home or, if you would like the information in a different form, please advise us in writing as to your preferences. We use a HIPAA compliant EHR system and email but please keep in mind there are inherent risks in electronic communication. If you would prefer to not utilize email as a form of communication, please inform Midlife Women’s Wellness Clinic in writing and please do not email the office. Sending an email to and asking questions pertaining to health or your personal information will be presumed as you are granting permission to communicate via email along with this signed HIPAA form.


You have the right to inspect and/or copy your health information for seven years from the date that the record was created for as long as the information remains in our files.  In addition, you have the right to request an amendment to your health information.  As per allowance by HIPAA recommendations & as a non-covered entity, the charge will be 25 cents per page. 


Requests to inspect, copy or amend your health-related information should be provided to us in writing.


We make every effort to follow the state and federal recommendations to maintain the privacy of your patient file and the health protected health information therein.


We also make every effort to follow the state and federal recommendations to provide you with this notice of our privacy practices with respect to your health information.  We make every effort to abide by the terms of this notice while it is in effect.


We reserve the right to alter or amend the terms of this privacy notice.  If changes are made to our privacy notice, we will notify you in writing as soon as possible following the changes.  Any change in our privacy notice will apply to all of your health information in our files.


You also have the right to lodge a complaint with the Secretary of the Department of Health and Human Services at 200 Independence Ave, S.W. Washington D.C. 20201.  If you choose to lodge a complaint with this office or with the Secretary your care will continue, and you will not be disadvantaged by this office or our staff in any manner whatsoever.

This notice is effective (updated) as of May 28, 2024. This notice and any alterations or amendments made here  will expire seven years after the date upon which the record was created.

All current updates to our Privacy Policy will be immediately applicable to you and all previous signers and posted on theMidlife Women’s Wellness Clinic website and in our Practice Better software. You may view them there or request an updated copy emailed to you at any time.
Contract Electronically:


You agree that the Terms, combined with your act of using the Site and/or the services offered on or through the Site have the same legal force and effect as a written contract with your written signature and satisfy any laws that require a writing or signature, including any applicable Statute of Frauds. You further agree that you shall not challenge the validity, enforceability, or admissibility of the Terms on the grounds that it was electronically transmitted or authorized. In addition, you acknowledge that you have had the opportunity to print the Terms.