Pharmacy

Preferred Pharmacy Address or Pharmacy Phone Number *

What is your preferred pharmacy? *

CONSENT FOR TREATMENT & LAB WORK

I consent to necessary treatment, including drugs, medication, performance of laboratory testing, imaging, or other studies that may be used by Lifetime Primary Care's clinical providers and staff.

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2. RELEASE OF INFORMATION & ELECTRONIC PRESCRIBING CONSENT

Release of Information

Some or all information in your medical records may need to be shared with other doctors or healthcare providers. Sometimes, other providers help assess a patient's condition, screen for potential issues, or offer consultations. All healthcare providers are legally required to maintain patient confidentiality.

Information about your care may also be shared with healthcare agencies, your insurance company, or your self-insured employer. Aside from verifying insurance coverage, data released to third parties may include statistical information used for quality care and outcome measurements.

Please be advised that in accordance with applicable laws and regulations, we may be required to share details pertaining to certain reportable illnesses or conditions with public health authorities. This reporting is intended to ensure proper monitoring, prevention, and control of diseases that may pose risks to public health. Rest assured that any information provided will be handled securely and in compliance with privacy standards. If you have any questions or concerns regarding this process, please feel free to reach out to our office for further clarification.

Consent for Electronic Prescribing

I understand that Lifetime Primary Care uses an electronic prescription system to send prescriptions and information between providers and pharmacies. My provider can see information about medications I'm already taking, including those from other providers. I consent to this access.

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3. SERVICE EXCLUSIONS

No disability/accident/injury exams.
No medical leave or paperwork visits.
No narcotic pain management visits.

3A. ADHD and Weight Loss Medication Exclusions

Florida - Stimulants and non-stimulant prescriptions are subject to provider discretion.
Other states - Due to varying state prescribing laws, stimulants are not available. Non-stimulant prescriptions are available and subject to the provider's discretion.

3B. Anxiety Medication Exclusions

NO controlled/narcotic prescriptions.
Other medications types are available and subject to the provider's discretion.

3C. Pain Medication Exclusions

NO controlled/narcotic prescriptions.
Other medications types are available and subject to the provider's discretion.

3D. Narcotic and Controlled Medication Policy

Lifetime Primary Care will not prescribe narcotics or controlled substances unless deemed necessary by the provider, or for severe illness or injury occurring within 24-48 hours of service. If needed, a specialist appointment is recommended and should be scheduled by the patient. Requests for such prescriptions after agreeing to this policy will be denied. Repeated requests will lead to dismissal from the practice.

3E. Document Policy and Exclusions

Lifetime Primary Care does not process external documents, letters, or forms. We do not engage in letter-writing services. Providers at our group are under no obligation to generate, complete, sign, or approve any external document or request including medical leave, workplace accommodations, or other paperwork requests.

3F. Disability, Accidents, and Injuries

Lifetime Primary Care focuses exclusively on comprehensive primary care and preventive health services. As such, we do not offer appointments for motor vehicle accidents, injury evaluations, or disability examinations.

3G. Appointment Wait Times - What to Expect
Visits with Lifetime Primary Care are reserved in Central Standard Time (CST). Lifetime Primary Care cannot guarantee exact visit times. Like an office visit, telehealth may involve a brief wait.

Please allow a 65 minute window for your visit. If you're not contacted for your telehealth visit within that timeframe, call or text us at 205-774-0309. If your schedule is tight, we would be happy to help you reschedule for a more convenient time. Please note that refunds cannot be issued for extended wait times, as certain factors in healthcare are beyond our office's control.

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FINANCIAL POLICIES
Pricing information is subject to change and is available on our website.

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5. AUTHORIZATION FOR RELEASE OF INFORMATION

I authorize the providers of Lifetime Primary Care to furnish any medical information requested by insurance companies with whom I have coverage, any public agency which may be assisting in payment of my care or my employer who is providing payment of my medical bills due to injury on the job.

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PATIENT AUTHORIZATION FOR USE OF TESTIMONIALS

I authorize Lifetime Primary Care to use and publish my testimonial or review, which may include my name and statements I have voluntarily provided, for marketing and promotional purposes in print, online, or on social media and third‑party platforms. I understand my participation is voluntary, that I will not receive compensation, that I may revoke this authorization in writing at any time (except where already relied upon), and that this authorization does not affect my care or benefits.

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Respect and Collaboration Policy

Lifetime Primary Care

We are committed to providing a safe, respectful environment for all patients and staff. Our team will treat you with compassion and professionalism, and we ask the same in return.

To maintain a positive experience for everyone, the following behaviors are not allowed. Please initial each item to confirm your understanding: *

1. Bullying – Intimidating or belittling staff or other patients
2. Disrespectful or Hostile Communication – Aggressive, argumentative, or rude language
3. Foul Language or Profanity – Swearing or using offensive words toward staff
4. Harassment – Repeated unwanted behavior, including verbal or non-verbal intimidation
5. Intimidation – Actions or words intended to create fear or discomfort
6. Physical Aggression – Throwing objects, hitting, or any form of physical violence
7. Racism or Discrimination – Racist remarks or discriminatory attitudes
8. Refusal to Cooperate – Ignoring instructions or refusing to follow office policies
9. Spreading Rumors or False Information – Harmful statements about staff or the practice
10. Threatening Language or Gestures – Verbal or physical threats toward staff, other patients, or our company
11. Verbal Abuse – Yelling, name-calling, or insulting language

Agreement

By signing below, you agree to treat our team and other patients with respect. Failure to follow this agreement may result in termination of care. If terminated, you will receive written notice and instructions for transferring your care to another provider. Thank you for your understanding and cooperation.

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Date Picker *

1. Provider Role Acknowledgment

This acknowledgment is intended to provide clarity about professional roles and how your care is delivered.

1. I acknowledge that Lifetime Primary Care in Hoover, Alabama was founded by Dr. Ebonee Lyons, a Family Nurse Practitioner who is not a physician. I understand that my primary care services may be provided by a non‑physician provider, including Family Nurse Practitioners or Physician Assistants (PAs).

2. I understand that nurse practitioners or PAs who hold doctorate‑level or master's degrees—such as a Doctor of Nursing Practice (DNP), Doctor of Philosophy in Nursing (PhD), or Master's of Science (MS)—are advanced practice providers and are not physicians. Nurse practitioners and physician assistants are highly trained to provide safe, evidence‑based care within their scope of practice. Their education, training, and licensure are different from those of physicians.

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Date Picker *

At Lifetime Primary Care, we operate under the assumption that you are establishing primary care. I understand that at Lifetime Primary Care, visits are treated as primary care unless I choose to decline. I may decline any service, including screenings, STI or HIV testing, at any time.

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