THE BODY PROJECT @ ASCEND Selection of the program level that best fits your needs!
1. Natural, functional approach support program without medications- $150 monthly membership with required monthly InBody/nurse check-in appointments, symptom, and diet support. (3-month minimum, medical appointments required every 3 months) ** initial: ______________ 2. Insurance-based or other practice-ordered medication support Program- $150 monthly membership with required monthly InBody/nurse check-in appointments, symptom and diet support. (3-month minimum, medical appointments required every 3 months) ** initial: ______________ 3. “You Got This” Support program- at-home dosing with minimal support, SEMAGLUTIDE/B12- $325 monthly . (3-month minimum, labs, medication shipped to your home, medical appointments required every 3 months) ** initial: ______________ 4. “You Got This” Support program- at-home dosing with minimal support, TIRZEPATIDE/NAD- $450 monthly (doses up to 5mg weekly), $600 (doses up to 7.5-10mg weekly) . (3-month minimum, labs, medication shipped to your home, medical appointments required every 3 months) ** initial: ______________ 5. Full Support plus SEMAGLUTIDE/B12 Injections included, + one Lipotropic injection (medical appointments required every 3 months)- $425 monthly ** initial: ______________ 6. Full Support plus TIRZEPATIDE/NAD Injections included, + one Lipotropic injection (medical appointments required every 3 months)- $675 monthly ** initial: ______________ All required labs will be ordered and included in cost at start of program and every 6 months. Further labs or supplements recommended are an additional cost- all on a case-by-case basis and will be discussed as needed. **Provider appointments will be sent thru insurance for BCBS and Sanford as able or at day of service cash pay rates without insurance. **Provider appointment day of service cash pay rates: Initial- $295 and Followup- $100 and InBody analysis $35 I understand the full program details after discussing all options with my provider @ ASCEND. I have selected the above program support level and choose to proceed with the Body Project. I understand that levels 1-4 require a 3-month minimum of automatic monthly payments before cancellation and that cancellation requests must be emailed to ascendwellnessmbs@gmail.com 30 days prior to the next processing date to process cancellation appropriately. A separate credit card authorization form will be completed. I consent to initiating the program, risks/benefits have been explained and all of my questions have been answered. __________________________________________ Printed Name: __________________________________________ ___________________________ Signature: Date:
We look forward to supporting your journey to better health! Ascend Wellness MBS www.ascendwellnessmbs.com
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