Effective Date: 4/6/2026
Welcome to Prime Form Care, LLC (“Company,” “we,” “our,” or “us”). By accessing or using this website, you agree to the following Terms and Conditions. If you do not agree, you should not use this website.
1. No Medical Advice
The content on this website is provided for informational purposes only and does not constitute medical advice, diagnosis, or treatment. You should not rely on any information on this website as a substitute for professional medical advice. Use of this website or services does not guarantee diagnosis, treatment, or the issuance of any prescription. All medical decisions are made at the discretion of the provider.
2. No Provider–Patient Relationship
Use of this website does not establish a provider–patient relationship between you and Prime Form Care, LLC or its provider, Viridiana Fuentes Rosales, FNP-C. A provider–patient relationship is only established after:
- Completion of required intake forms
- Review by the provider
- Formal acceptance into care
3. Telehealth Services
Prime Form Care provides services via telehealth. Services are provided via telehealth where clinically appropriate and in accordance with applicable state and federal laws.
Telehealth services are subject to additional terms, including informed consent, which must be reviewed and signed prior to receiving care.
4. Not for Emergencies
This website and services are not intended for emergency medical situations.
If you are experiencing a medical emergency, call 911 or go to the nearest emergency room.
5. Use of Website
You agree to use this website only for lawful purposes. You may not:
- Attempt to gain unauthorized access to the website
- Use the website in a way that disrupts functionality
- Submit false or misleading information
6. Intellectual Property
All content on this website, including text, graphics, logos, and design, is the property of Prime Form Care, LLC and is protected by applicable intellectual property laws.
You may not reproduce, distribute, or use content without prior written permission.
7. Third-Party Services
This website may reference or link to third-party services, including:
- Electronic health record systems
- Laboratories
- Pharmacies
- Payment processors
If treatment is prescribed, prescriptions may be fulfilled by third-party pharmacies. Prime Form Care does not manufacture medications and is not responsible for pharmacy operations, fulfillment, or outcomes.
8. Payment and Services
Prime Form Care operates as a self-pay practice and does not bill insurance.
All services are subject to separate financial policies, which must be reviewed and agreed to prior to receiving care.
Fees may vary depending on services, laboratory testing, and treatment plans.
9. No Guarantee of Results
Individual results may vary. Prime Form Care does not guarantee specific outcomes from any services or treatments.
10. Service Eligibility:
Services are intended for adults age 18 and older.
11. Limitation of Liability
To the fullest extent permitted by law, Prime Form Care, LLC shall not be liable for any indirect, incidental, or consequential damages arising from:
- Use of this website
- Reliance on information provided
- Inability to access services
12. Indemnification
You agree to indemnify and hold harmless Prime Form Care, LLC and its provider from any claims, damages, or liabilities arising from your use of this website or violation of these Terms.
13. Governing Law
These Terms and Conditions are governed by the laws of the Commonwealth of Virginia, without regard to conflict of law principles.
14. Changes to Terms
We reserve the right to update these Terms and Conditions at any time. Updates will be posted on this page with a revised effective date.
15. Contact Information
If you have questions about these Terms and Conditions, you may contact:
Prime Form Care, LLC
Email: contact@primeformcare.com
Website: www.primeformcare.com
FINANCIAL POLICY, MEMBERSHIP AGREEMENT & NO-SHOW POLICY
Effective Date: 4/6/2026
Prime Form Care, LLC (“Prime Form Care,” “we,” “our,” or “us”) is a self-pay medical practice.
Self-Pay Practice
Prime Form Care is a self-pay practice and does not bill or accept insurance. Patients are responsible for all costs of care.
Services may be eligible for reimbursement through HSA/FSA accounts; however, reimbursement is not guaranteed.
Payment Responsibility
- Payment is required at the time of service unless otherwise stated
- Patients are responsible for all fees associated with their care
- Fees may include consultations, membership, laboratory services, medications, and other services
Membership Agreement (If Applicable)
- Membership fees are billed on a recurring basis (monthly or as selected at enrollment)
- Billing occurs automatically on the same date each cycle
- Membership includes only the services outlined at enrollment
- Membership does not include medications, laboratory testing, or third-party services unless explicitly stated
- Membership does not guarantee specific outcomes
Recurring Billing
By scheduling services or enrolling in a membership, patients authorize Prime Form Care, LLC to charge the payment method on file for:
- Membership fees
- Services rendered
- Applicable fees, including cancellation and no-show fees
Cancellation Policy (Membership)
- Membership cancellation must be requested prior to the next billing cycle
- No partial refunds are issued for unused time
- Once billed, membership fees are non-refundable
Appointment & Cancellation Policy
- A valid payment method must be maintained on file
- Appointments must be canceled or rescheduled at least 24 hours in advance
- Cancellations within 24 hours or missed appointments will result in a $50 cancellation fee, charged to the payment method on file
- This fee is intended to compensate for reserved appointment time and administrative costs
Refund Policy
- All services are non-refundable once rendered
- Medications, laboratory services, and third-party services are non-refundable
- Membership fees are non-refundable after billing
Chargebacks & Disputes
Patients are expected to contact Prime Form Care to resolve billing concerns prior to initiating a chargeback.
Improper chargebacks may result in:
- Termination of services
- Referral to collections
- Additional administrative fees
- Recovery of associated fees where permitted by law
Failed Payments
Failed or declined payments may result in:
- Suspension of services
- Account hold until resolved
- Additional fees
Termination of Services
Prime Form Care reserves the right to suspend or terminate services for:
- Non-payment
- Repeated missed appointments
- Violation of policies
Third-Party Purchases
Certain products (including supplements and medications) may be purchased through third-party platforms and are subject to their terms and policies.