MEMBERSHIP DISCLAIMERS, TERMS AND CONDITIONS FOR FUNCTIONAL MEDICINE SERVICES AT
NORTH SHORE PRO-ACTIVE HEALTH

 
FEES:  

Payment is processed with automatic monthly membership billing.  North Shore Pro-Active Health uses encrypted, HIPAA compliant software Jane for  appointment scheduling and kajabi (this platform) for billing.  Alternative payment methods are accepted (cash and check) on a case-by-case basis. 

• All Inclusive MEMBERSHIP:  $4497; $999 per month for 5 months (with one time $997 set up fee) 
• Annual MAINTENANCE CARE $1497
• Single 20 min office VISIT: $197
• Single 60 min office visit: $547

Many HSA and Flex accounts cover medical services, such as functional medicine. It is up to you, as the Member, to check your specific HSA/Flex account. Upon request, North Shore Pro-Active Health will provide proper superbill (including ICD-10 codes) but does not guarantee this is a covered service for your specific HSA/Flex plan.

If you, as a Member, are eligible for Medicare (or during the term of this Agreement become eligible for Medicare) then by signing this document, you acknowledge your understanding that the delivered services are not a covered benefit as delivered by Chiropractors, and as a result, Medicare cannot be billed for any services performed for you by the Practitioner.  You agree not to bill Medicare or attempt Medicare reimbursement for any such services. 

INITIAL VISIT ($997) includes the following:

• 75 minute office visit with complete history and physical examination
• Welcome Kit (informational packet, professional binder, gratitude journal, vitamin organizer) 
• Personalized nutraceutical protocol.
• Eight Point Prescription including Nutrition, Exercise, Sleep, Supplements and more. Delivered at ROF as part of Membership.

ALL INCLUSIVE MEMBERSHIP SUBSCRIPTION (for ongoing care):

• 60 minute Report of Findings Visit (completed 1-2 weeks after Initial Registration Visit)
• SEVEN 30 minute sessions of dedicated private Functional Medical time with Dr. Jordan Leasure 
• SEVEN 30 minute sessions of dedicated private Functional Nutrition time with our Functional Medicine Nutritional Coach (one practitioner seen every 10 days)
• Personalized nutraceutical protocol adjusted regularly to meet needs
• Optimal Blood Chemistry Reports on ALL previous and current blood work (completed in last 3 years)
• Weekly LIVE Open Office Hours with Dr. Leasure
• Specialty testing recommendations (Testing as needed - up to TWO tests included in program)
• 10% off any additional labs
• 15% discount on medical grade nutraceuticals to compliment the program.
• 25% off any other current Leasure Life Programs including: Gut Healing Program, Detox, Reboot, etc.
• Six Month Access to Leasure Life Membership including Meal Plans, Monthly Habit Integration, and Open Office Hours.
• Masterclasses released during our time together

MAINTENANCE CARE (for ongoing care after All-Inclusive has concluded):

• Twelve month access to Leasure Life Membership including Meal Plans, Monthly Habit Integration, and Open Office Hours.
• Two 30 Minute 1:1 Visits with Dr. Leasure
• Quarterly Visits (4) with our Functional Nutritional Consultant
• Two Optimal Blood Chemistry Reports
• Weekly Live Q & A in Open Office Hours with Dr. Leasure (shared group visits)
• 10% discount on additional services & supplements

BASIC ACCESS PASS (educational support only):  

• 10% discount in medical grade nutraceuticals
• Access to Leasure Life Membership including Meal Plans, Monthly Habit Integration, Workouts and classes
• If private medical care is needed, priority scheduling for the Initial Visit ($997) is given
• If person has already completed Deluxe/Active membership, then they have the option to schedule additional appointments at full prices:
• 20 minute in-office follow-up: $197
• 60 minute in-depth office consultation: $547
• DOES NOT INCLUDE DIRECT MESSAGING TO Dr. Jordan Leasure IN THE PATIENT PORTAL.  
• WHEN PURCHASED AS INITIAL OPTION (without Deluxe or Active Membership first), this does NOT constitute physician/patient relationship.  This is EDUCATIONAL ONLY.

LAB FEES  

Dr. Jordan Leasure has established contracts with several specialty labs, including (but not limited to) Doctor’s Data, Genova, Great Plains Laboratory, ZRT, Diagnostics Solutions, and Labrix.   Dr. Jordan Leasure will be transparent in regard to all pricing, as payment may be submitted directly to the lab. Dr. Jordan Leasure does not perform laboratory testing in her office.

ASSUMPTIONS FOR MEMBERS:

• As a Member, you take responsibility for scheduling and completing your monthly visits.
• As a Member, you are under the care of an outside primary care practitioner and should discuss any dietary changes or potential dietary supplements use with his/ her primary doctor.
• As a Member, you should not discontinue any prescription medications without first consulting your prescribing doctor.
• As a Member, you recognize this Agreement is not a guarantee of results and deals solely with the services to be rendered and the fees to be paid for the support provided.
• As a Member, your payment obligation is not contingent upon the outcome of care.
• You take full responsibility for your life and well-being, and all decisions made during and after this program.
• You expressly assume the risks of the Membership, including the risks of trying new foods or supplements, and the risks inherent in making lifestyle changes.     
• You release North Shore Pro-Active Health and Dr. Jordan Leasure from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Member ever had, now has or will have in the future against North Shore Pro-Active Health and Dr. Jordan Leasure, arising from the Member’s past or future participation in, or otherwise with respect to, the Membership, unless arising from the gross negligence of North Shore Pro-Active Health and Dr. Jordan Leasure.

ASSUMPTIONS FOR NORTH SHORE PRO-ACTIVE HEALTH’S MEDICAL SERVICES:

• One-on-one Functional Medical support with Dr. Jordan Leasure in regards to the Member’s chronic health conditions totaling the number set forth based on Membership Type
• Unlimited access to all group programs, including condition-specific group medical visits and topic-specific group classes.
• Comprehensive services, including: administrative paperwork such as referrals, filling out forms and communicating with other medical providers. Additional fees may apply
• Non-urgent email access within delineated boundaries set forth (Monday-Thursday)
• Access to nutraceutical products at discounted rates.
• Discounts on miscellaneous services provided by community affiliate partners as recommended to the Member by Dr. Jordan Leasure
• Access to specialty testing at discounted cost as recommended by Dr. Jordan Leasure (based on Membership type)
• Access to Holistic Lending Library of books for check out
  
   

 ANY PROGRAMS OUTSIDE OF 1:1 IN PERSON FUNCTIONAL MEDICINE APPOINTMENT DOES NOT ESTABLISH A DOCTOR-PATIENT RELATIONSHIP AND ARE FOR THE PURPOSES OF EDUCATION ONLY.
VIRTUAL PROGRAMS ARE NON-REFUNDABLE AFTER THEIR REGISTRATION/START DATE OR AS SOON AS ACCESS IS GRANTED AS THESE PROGRAMS CONTAIN MATERIALS THAT ARE EVERGREEN AND/OR DIGITAL AND CANNOT BE RETURNED OR REFUNDED IRREGARDLESS OF DEGREE OF CLIENT PARTICIPATION.

Contact Us

If you have any questions, concerns or complaints about this Functional Medicine Policy, please contact us:

• By email: [email protected]
• By phone number: 847.362.4476
• By mail: NSPAH 112 Lake St. Libertyville, IL 60048
  
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