In connection with your treatment at OneSpotMD Primary and Urgent Care PLLC, your OneSpotMD Primary and Urgent Care PLLC healthcare provider may recommend certain ancillary services as part of your overall care. OneSpotMD Primary and Urgent Care PLLC offers certain ancillary services that patients may require such as X-ray, limited lab services, and certain pharmaceuticals. OneSpotMD Primary and Urgent Care PLLC has arranged for limited durable equipment (DME) to be available on site for patient convenience through a third-party vendor. While OneSpotMD Primary and Urgent Care PLLC makes these services available, we want you to know that if your OneSpotMD Primary and Urgent Care PLLC healthcare provider prescribes any of these services for you, you are free to choose any provider or supplier you wish and are not required to obtain these services through or at OneSpotMD Primary and Urgent Care PLLC. OneSpotMD Primary and Urgent Care PLLC will offer local providers of such items and services to you upon your request.

I have been given the opportunity to review the forgoing regarding OneSpotMD Primary and Urgent Care PLLC’s Patient Choice Policy and have had any questions answered about the same addressed. By signing below, I acknowledge my understanding of this policy and my rights thereunder.