Basic Plan
|
Total Plan
|
Ultimate Plan
|
| 1 Annual Physical | 1 Annual Physical | 1 Annual Physical |
| Online Appointments | Online Appointments | Online Appointments |
| Medication Management | Medication Management | Medication Management |
| Lab Test (Annual) | Lab Test (Annual) | Lab Test (Annual) |
| • Cholesterol | • Cholesterol | • Cholesterol |
| • Blood Sugar | • Blood Sugar | • Blood Sugar |
| • CBC | • CBC | • CBC |
| • CMP | • CMP | • CMP |
| • Lipids | • Lipids | • Lipids |
| • Urinalysis | • Urinalysis | • Urinalysis |
| •Hemoglobin A1-C | • Hemoglobin A1-C | |
| ONLY $399 | ONLY $699 | ONLY $999 |
| $1,200 value | $1,500 value | $1,800 value |
I understand THIS IS NOT AN INSURANCE PLAN. (required)
I understand that the services provided by Tampa Heights Medical Center is limited to doctor office visits at Tampa Heights Medical Center. Any labs or x rays, with the exception of the lab tests included in the Basic, Total or Ultimate Plans, will not be covered by this service. In addition, no Emergency Room or hospital visits; or consultations with any specialists (cardiology, neurology, etc…); or any other medical service provided by anyone other than providers at Tampa Heights Medical Center are not included in the services provided by Tampa Heights Medical Center and will be the financial responsibility of the patient. I have read all the above and understand and agree to all provisions therein.