Fine Wines Medical, P.C. Inc.
Effective date: October 7, 2026
In this document, "Fine Wines Medical," "the practice," "we," and "us" refer to Fine Wines Medical, P.C. Inc.
Consent to Medical Care
Fine Wines Medical provides physician-led telehealth care for women's health and gynecology, including perimenopause, menopause, and related health concerns. I consent to evaluation and treatment by a physician, physician assistant, or nurse practitioner on Dr. Okasi's medical team acting within their authorized scope of practice. Care may include medical evaluation, review of symptoms and history, laboratory testing, lifestyle recommendations, prescription medication, non-hormonal treatment, hormone therapy, and weight management when appropriate.
I confirm that I am 18 or older. Evaluation does not guarantee a prescription or eligibility for any particular treatment. Results are not guaranteed. I may ask about benefits, risks, alternatives, and declining treatment. Treatment-specific consent may be required before prescribing certain medications. I will provide accurate health information and promptly report side effects or changes in my health.
Financial Policy
Fine Wines Medical is a self-pay practice. All fees are prepaid. We do not accept or bill insurance for our professional services or file claims on your behalf. We accept credit cards, debit cards, HSA cards, and FSA cards. Charges will appear on your statement as Fine Wines Medical. A superbill is available on request, but insurance reimbursement is not guaranteed.
The practice does not provide services to patients enrolled in Medicare Part A or Part B. I confirm that I am not currently enrolled. I will notify the practice if my status changes, and I will transition my care to another provider of my choice.
Fees and Membership
Initial Comprehensive Evaluation: $199, paid at booking. Your appointment is confirmed after payment and completion of the intake questionnaire. This fee covers a clinical assessment, not a specific medication or product.
Ongoing Care Membership: $79 per month, starting 30 days after your completed initial evaluation, only if you begin a treatment plan and enroll in membership. Membership is required for ongoing prescriptions, refills, and medication renewals and is billed monthly until cancellation takes effect. To avoid your next charge, cancel at least TEN (10) days before your next billing date. Membership includes ongoing medical management, one asynchronous check-in per billing period, medication adjustments and lab review when clinically appropriate, and access to the Audacity of Midlife Live Masterclasses. A check-in is one portal conversation about one topic and closes at the end of the next business day after your clinician's first response. If your clinician asks for clarification, the conversation may continue until that check-in is completed. Unused check-ins do not carry forward. Established Patient Video visits are billed separately.
Established Patient Video Visits: $99 each, scheduled and paid through the patient portal.
Medications: Charged separately. Medication supplied through our partner pharmacy is prepaid and charged before each shipment, subject to clinician approval. We bill and fulfill hormone therapy as a 3-month supply every 90 days. We bill and fulfill weight-management medications (GLP-1s) strictly as a 1-month (30-day) supply to allow safe monthly titration. We will charge your card for the upcoming GLP-1 vial and shipping upon clinical approval of your MANDATORY monthly check-in. GLP-1 medication costs may scale up as your prescribed dosage increases. Whether you complete your check-in or not, your $79 subscription remains in effect until cancellation. If your clinician does not approve a renewal, you will not be charged, and you may need a visit. For other prescriptions filled at a local pharmacy, you will pay them directly.
Laboratory testing: Performed and billed by Labcorp. You may use insurance accepted by the laboratory or pay Labcorp directly. You are responsible for any charges your insurance does not cover. Laboratory testing, medications, and outside healthcare services are not included in membership.
Special forms and letters: $50 per document, prepaid. If extensive work requires a higher fee, we will get your agreement before preparing it.
We will notify you at least 30 days before any change to recurring prices.
Appointment Cancellations and Missed Visits
These rules apply to the $199 Initial Comprehensive Evaluation and $99 Established Patient Video Visits. They do not apply to the monthly membership check-in.
- More than 48 hours' notice: If you cancel more than 48 hours before your appointment, you will receive a full refund.
- Rescheduling: Otherwise, you may reschedule once at no charge, including after missing your first appointment.
- Forfeiture: If you miss your rescheduled appointment or request a second reschedule, you forfeit the visit fee.
- Late arrival: Joining more than 10 minutes late, or being unable to connect, counts as a missed appointment. Technical problems on the practice's side do not count as a missed appointment.
- Practice cancellations: If the practice cancels, rescheduling is free and does not use your courtesy reschedule.
Canceling Membership and Medications
Cancel through the patient portal, or by fax at 410-730-7725 if you cannot access the portal. Canceling membership also cancels future medication renewals, and canceling recurring medication shipments also cancels membership.
Two deadlines apply:
- Membership: Cancel at least 10 days before your next billing date to avoid the next $79 charge. Your membership then continues through your current paid period and ends before the next charge. If you cancel later, the next charge applies, and your membership continues through that paid month and then ends.
- Medication: Cancel at least 10 days before your next scheduled shipment date, shown in your portal, to avoid the next medication charge. If you cancel later, that order will ship and be charged.
Example: If you cancel 5 days before both your billing date and your shipment date, you will pay for the upcoming 3-month medication supply and one more $79 membership month. Your membership ends after that month. Your remaining medication supply does not extend provider access, and you will need to arrange ongoing care with another provider.
After membership ends, routine prescribing and refills stop, subject to appropriate clinical transition. Canceling is not an instruction to stop medication abruptly. Returning patients need a new $199 evaluation and updated testing when clinically indicated.
Refunds
Except for appointment cancellations made more than 48 hours in advance, or as required by law, all fees are non-refundable. This includes partial membership periods, processed medication orders, and unused medication. You cannot cancel or return processed medication orders. Report damaged or incorrect shipments through the portal within 3 days of delivery, and we will help arrange a replacement. Do not use incorrect or damaged medication.
Failed Payments
If a recurring payment is declined, routine membership services and medication shipments will pause until your account is up to date. You must pay any outstanding balance before services resume.
Payment Method
The practice and its payment processor securely retain your payment credential for authorized charges. Please keep it current. Recurring charges are authorized separately at checkout when you enroll. Revoking future authorization does not eliminate charges already incurred.
Medical Records
You can access visit notes and other available records at no charge through the patient portal. You can also access laboratory results through Labcorp's portal. You may request copies, or a transfer to another provider, through the portal or by fax. We fulfill requests within 30 days, or sooner when required by law. Electronic copies are free. Paper copies are $0.50 per page plus actual postage, subject to applicable legal cost limits.
Telehealth Consent
I consent to telehealth care, including video and asynchronous care. Risks include technical interruptions, unauthorized access, and limits on examination and assessment. Either my clinician or I may stop a visit if the connection is inadequate. My clinician may require an in-person examination or outside care when telehealth is not suitable.
I will disclose my physical location when receiving care, and I must be in a state where my treating clinician is authorized to practice. I will disclose anyone else present during a visit and protect my portal login and visit links. Telephone-only consultations may be used when appropriate and legally permitted, but a video or in-person evaluation may still be required.
Portal Communication
Clinical communication takes place through the secure patient portal. You can expect a response to a nonurgent check-in within 5 business days. The portal is not monitored continuously. Check-ins concern your established treatment plan, and your clinician decides whether a concern can be handled through messaging or requires a video visit. You may report medication side effects and safety concerns at any time, whether or not you have used your monthly check-in.
Do not use the portal for emergencies or concerns that cannot safely wait. For an emergency, call 911 or go to the nearest emergency department. For urgent concerns, seek timely local care rather than waiting for a portal response.
Automated Notices
I agree to receive automated appointment reminders and account notices by text message and email. These messages will not contain clinical details. Message and data rates may apply. You may opt out of text reminders by replying STOP or request an email opt-out through the portal. You remain responsible for checking your patient portal for messages and account notices.
Masterclasses
Membership includes access to the Audacity of Midlife Live Masterclasses on Skool. Members receive a registration link through the patient portal. Masterclasses are general education in a group setting, not individual medical advice.
Privacy and HIPAA
We protect your health information as required by law. We may use or share it for treatment, payment, practice operations, and other purposes permitted or required by law, including appropriate sharing with laboratories, pharmacies, and service providers. We may provide information about treatment alternatives, our healthcare services, and health-related programs when legally permitted. You may ask us to stop promotional communications. Uses that require written authorization will not be made on the basis of this general consent alone. You may revoke an authorization through the portal or by fax, except where we have already relied on it.
You may request records, amendments, an accounting of certain disclosures, restrictions, and confidential communications. We will honor a request not to share information with a health plan about services you paid for in full, unless the law requires disclosure. You may file a complaint with the practice or with the U.S. Department of Health and Human Services without retaliation. The full Notice of Privacy Practices is available in the patient portal, and this summary does not replace it.
Privacy contact: Dr. Chetanna Okasi, Privacy Officer
Phone: 667-300-2604
Fax: 410-730-7725
Or through the patient portal
Patient Participation and Acknowledgment
I have the right to respectful care, privacy, information about my clinician and treatment options, and participation in decisions about my care. I will provide complete health information, report changes, follow agreed care instructions, ask questions, and keep appointments or give timely notice.
By signing, I confirm that I have read this document or had it explained to me, had the opportunity to ask questions, consent to the care described, and agree to the financial and payment terms for services in which I enroll. I acknowledge receipt of the Notice of Privacy Practices. This acknowledgment does not waive my privacy rights or authorize uses that require specific authorization.