NAVARA HEALTH

Functional · Hormonal · Integrative

Adult Membership Agreement

Virtual Direct Primary Care
Scope of Care & Informed Consent

Program Description

Virtual Direct Primary Care (DPC) is a cash-pay medical membership providing adult patients access to general primary care services through secure video and telephone visits.

This membership is designed to provide

• Preventive and wellness care
• Acute illness evaluation
• Stable chronic condition management
• Non-controlled medication management
• General medical oversight

Membership Pricing & Billing

Navara Health does not participate with Medicare or Medicaid.

Item	Detail	Fee
Monthly Membership	Ages 18–59	$99 / month
Monthly Membership	Ages 60+	$139 / month
Enrollment Fee	One-time, non-refundable	$100
Annual Prepay	12 months paid in full	15% discount
Late Fee	Applied after 3 days past due	$25

Enrollment Fee

The enrollment fee covers administrative onboarding and chart creation. It is non-refundable, is not applied toward monthly membership fees, and does not represent prepaid medical services.

Billing Policies

• A valid debit or credit card must remain on file
• Membership is automatically billed monthly on the enrollment anniversary date
• A $25 late fee applies after three (3) days past due
• Accounts thirty (30) days past due will be placed in inactive status
• Services are suspended while inactive
• Annual prepay is non-refundable
• Re-enrollment after termination is not guaranteed and may require a new enrollment fee

Visit Structure & Response Times

Membership includes up to two (2) virtual visits per month. Additional visits beyond the monthly allowance may be available at the provider's discretion for an additional fee.

Visit requests must be submitted through the secure patient portal. Patients do not self-schedule on a public calendar.

Provider Response Time

• Responses occur as soon as reasonably possible and within 24 business hours during normal business hours
• Messages received after hours, on weekends, or on holidays are addressed the next business day
• All care is delivered via secure video or telephone
• This program is not appropriate for urgent or emergency conditions

All scheduling and response times operate in Central Time (Dallas, Texas), regardless of patient location.

Communication, Technology & HIPAA Authorization

All clinical communication occurs through a HIPAA-compliant patient portal. By signing this agreement, the patient authorizes Navara Health to communicate with them through the following channels for the purposes of care coordination, scheduling, billing, and follow-up:

• Secure messaging within the patient portal
• Email correspondence to the address provided
• SMS/text messages to the mobile number provided (appointment reminders, portal notifications, refill updates)
• Telephone calls to the number provided

The patient understands that email and SMS are not fully secure channels and that limited protected health information may be transmitted through these methods at the patient's request and acknowledged risk. Sensitive clinical communication will be routed through the secure portal whenever possible.

The patient may revoke authorization for any specific communication channel by written request to contact@navarahealthtx.com, except where the channel is required for legally mandated notices.

Patients may use the portal to

• Send and receive secure messages
• Participate in video or phone visits
• Complete digital forms and consents
• Receive lab orders, referrals, and medical documentation

Services Included

This membership includes general adult primary care services only:

• Preventive care and annual wellness review
• Acute illness evaluation
• Stable chronic condition management
• Pre-diabetes and Type 2 diabetes not requiring insulin
• Non-controlled medication refills
• Lab ordering and interpretation
• Imaging orders and specialist referrals
• Secure provider messaging

Services Excluded

The following services are NOT included in DPC membership and require separate enrollment, consent, and billing:

• GLP-1 and metabolic weight-loss programs
• Hormone replacement therapy (HRT / BHRT)
• Testosterone therapy
• Peptide therapy
• IV therapy and injectable wellness services
• Aesthetic services

Additional exclusions

• Pediatric care (under 18)
• Emergency, urgent, or hospital-level care
• Insulin initiation, titration, or pump management
• Addiction medicine and detoxification
• Crisis-level psychiatric care
• All controlled substances, including ADHD stimulants, benzodiazepines, opioids, phentermine, controlled sleep medications, buprenorphine / Suboxone, and methadone

Mental Health Policy

Non-controlled anxiety or depression medications may be continued only when:

• The patient is clinically stable
• Prior records or pharmacy verification are provided
• The patient is not in acute crisis

This practice does not initiate new psychiatric medications, manage treatment-resistant depression, or provide crisis mental health management. Patients requiring more intensive psychiatric care will be referred to specialty services.

Optimization Programs

GLP-1 therapy, hormone therapy, peptide therapy, and other optimization programs are separate from DPC membership and require:

• Separate enrollment and intake
• Program-specific informed consent
• Program-specific baseline and monitoring labs
• Separate fees

Participation in DPC does not guarantee eligibility for optimization programs. Eligibility is determined clinically on a case-by-case basis.

Medication Sourcing

Medications may be prescribed through:

• Commercial retail pharmacies
• Select 503A and 503B compounding pharmacies

Compounded medications require separate informed consent. The patient is responsible for all medication costs, including any out-of-pocket expense not covered by insurance.

Manufacturer GLP-1 Programs

Manufacturer cash-pay programs (such as LillyDirect and similar) require:

• Continuous 30-day refills
• No dose splitting or microdosing
• No skipped or paused months

Failure to comply with manufacturer terms may result in loss of program eligibility. This is determined by the manufacturer, not by Navara Health.

Controlled Substances & Testosterone Therapy

Testosterone is a Schedule III controlled substance under federal law. Navara Health does not prescribe testosterone, anabolic steroids, or any other controlled substance through the virtual DPC membership.

Patients seeking testosterone therapy must enroll separately in the Men's Hormone Optimization program, which requires:

• A valid practitioner-patient relationship consistent with the laws of the patient's state
• In-person evaluation where required by state law
• Comprehensive baseline laboratory evaluation
• Ongoing monitoring labs at clinically appropriate intervals
• Compliance with all applicable state and federal controlled substance regulations

Lab Monitoring & Financial Responsibility

Insurance coverage for labs and imaging is not guaranteed. The patient is financially responsible for:

• All laboratory charges
• Imaging and diagnostic study costs
• Specialist consultation fees
• Any out-of-network or facility-based services

Cash-pay labs must be paid prior to ordering. Required monitoring labs must be completed before medication refills are issued.

HSA / FSA & Superbills

Navara Health is a cash-pay practice. The clinic does not:

• Bill any insurance plan
• Verify insurance benefits
• Submit insurance claims

Superbills may be provided upon written request for the patient's own use. Reimbursement is determined by the patient's insurer and is not guaranteed.

Administrative Forms & Fees

Completion of employer, disability, FMLA, legal, or other administrative forms:

• Is at provider discretion
• May require medical director review
• May incur additional fees, disclosed in advance

Medical Director Oversight

Navara Health operates under a written collaborative practice agreement with Simal Patel, MD. Patient charts may be reviewed in accordance with state and federal regulations and the terms of that agreement.

Membership Term & Cancellation

• A 90-day minimum commitment is required at enrollment
• After 90 days, membership converts to month-to-month
• Cancellation requires seven (7) days written notice to contact@navarahealthtx.com
• No partial or retroactive refunds are provided
• Annual prepay is non-refundable

Termination of the Practitioner-Patient Relationship

Navara Health reserves the right to terminate the practitioner-patient relationship with written notice for any of the following:

• Non-payment of fees after written notice
• Repeated non-compliance with the treatment plan, including failure to complete required monitoring labs
• Abusive, threatening, or harassing behavior toward the provider, staff, or medical director
• Misrepresentation of medical history or identity
• Drug-seeking behavior or attempted diversion
• Use of services in a manner inconsistent with the scope of this membership
• Conduct that creates a clinical, legal, or safety risk for the practice

Where required by state law, the practice will provide written notice and a reasonable continuity-of-care period (typically 30 days) for the patient to establish care elsewhere, except where immediate termination is warranted by safety concerns.

Inactive Status

Accounts thirty (30) days past due are placed in inactive status. During inactive status, refills, messaging, scheduling, and care coordination are suspended. Inactive status is not termination of the practitioner-patient relationship. Outstanding balances remain due.

Medicare & Medicaid

By enrolling, the patient certifies that they are not currently enrolled in Medicare or Medicaid. If this status changes during membership, the patient agrees to notify the clinic immediately. Enrollment while covered by Medicare or Medicaid results in immediate termination of membership without refund.

Dispute Resolution & Binding Arbitration

Any dispute, controversy, or claim arising out of or relating to this Agreement, the services provided, or the practitioner-patient relationship — including any claim of medical malpractice, billing dispute, or breach of contract — shall first be addressed by good-faith negotiation between the parties.

If the matter cannot be resolved through negotiation within thirty (30) days, the parties agree to submit the dispute to binding arbitration administered by a recognized arbitration body (such as the American Arbitration Association) under its applicable rules, with the arbitration to take place in Dallas County, Texas, unless otherwise required by the patient's state of residence.

The parties acknowledge that by agreeing to arbitration, they are waiving the right to a jury trial. This provision does not waive any right that cannot lawfully be waived under the patient's state law. Either party retains the right to seek injunctive or equitable relief in court where appropriate.

Governing Law

This Agreement shall be governed by and construed under the laws of the State of Texas, except where the laws of the patient's state of residence require otherwise for healthcare services delivered to residents of that state. If any provision of this Agreement is found unenforceable, the remaining provisions shall remain in full force and effect.

Emergency Disclaimer