Physician Referral — Discovery Call Form

Physician Referral

Referred Patient Intake with Dr. Cruz
A Service of My Wellness Physicians

Discovery Call Form

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Call Details

1

Referring Provider

You: Good afternoon, this is [Keith] with My Wellness Physicians. Dr. [referring provider] referred you to us — is this still a good time to talk for a few minutes?
2

Service Being Referred For

You: Let me make sure I have the right service lined up — what did Dr. [referring provider] say you were being referred here for?
3

Quick Screening

You: If you don't mind a few quick questions — these help Dr. Cruz prepare so you get the most out of your visit.
Pregnant or trying to conceive?
Hx cancer (any type)?
Hx blood clot / DVT / PE / stroke / heart attack?
4

Program & Fee (auto-fills from service selected above)

Select a service in Stage 2 to load the relevant talking points and pricing.
Testosterone Therapy — what it includes
  • 1-hour consultation with Dr. Cruz, double board-certified, comprehensive baseline labs (total/free T, SHBG, LH/FSH, estradiol, PSA, CBC/hematocrit).
  • Delivery method matched to the patient — injection, cream, or pellet — when clinically appropriate.
  • Fertility-preserving options discussed when having children is a priority.
  • Ongoing monitoring with dose adjustments, including hematocrit and PSA.
TRT Initial Consultation — labs included — $600 one-time
TRT Ongoing — consult, labs & medication — $550 / quarter
Cash-pay, subject to change — confirm with Dr. Cruz before quoting.
Hormone Therapy — what it includes
  • Physician-led evaluation for perimenopause/menopause symptoms — hot flashes, mood, sleep, libido, brain fog.
  • Comprehensive hormone panel and whole-person workup with Dr. Cruz.
  • Individualized dosing and delivery method, with ongoing monitoring.
Pricing not yet loaded for this tool — confirm current HRT consult and ongoing fees with Dr. Cruz before quoting.
Medical Weight Loss / Obesity Medicine — what it includes
  • Evaluation with Dr. Cruz, double board-certified in Obesity Medicine (DABOM).
  • GLP-1 / semaglutide and other FDA-approved medication management as clinically appropriate.
  • Comprehensive metabolic workup; nutrition support available with Allison Tepper, RD.
  • Ongoing monitoring and dose titration.
Pricing not yet loaded for this tool — confirm current weight loss consult and program fees with Dr. Cruz before quoting.
LiLy Collaborative (Lipedema / Lymphedema) — what it includes
  • Multidisciplinary team: Dr. Cruz (physician evaluation, staging), Dr. Grace Villaver DPT/CLT (physical therapy & lymphedema treatment), Allison Tepper RD (nutrition).
  • Physical exam, staging/typing, and treatment plan built around the patient's presentation.
  • Vein referral partnership with Dr. Czestochowa Francois (Center for Vein Restoration) when indicated.
Pricing not yet loaded for this tool — confirm current LiLy consult and program fees with Dr. Cruz before quoting.
IV Therapy & Peptides — what it includes
  • Physician-supervised IV hydration/vitamin therapy and peptide protocols as clinically appropriate.
Pricing not yet loaded for this tool — confirm current IV/peptide pricing with Dr. Cruz before quoting.
Primary Care Membership — what it includes
  • Concierge primary care membership with direct access to Dr. Cruz.
Pricing not yet loaded for this tool — confirm current membership fees with Dr. Cruz before quoting.
Aesthetics — what it includes
  • Aesthetic services offered at MWP — confirm current menu with the front desk / Dr. Cruz.
Pricing not yet loaded for this tool — confirm current aesthetics pricing before quoting.
Telemedicine Weight Loss — what it includes
  • Virtual weight loss visits for Virginia residents when clinically appropriate.
  • GLP-1 management and follow-up via telehealth.
Pricing not yet loaded for this tool — confirm current telemedicine weight loss pricing with Dr. Cruz before quoting.
Not specified — general new patient path
  • Dr. Cruz will review the referral and patient history to determine the best-fit service at the visit.
No specific service selected — do not quote pricing. Confirm appropriate visit type with Dr. Cruz.
Objection responses (tap to expand)
"Does my insurance cover this?"
We're concierge and out-of-network — that's what lets Dr. Cruz spend real time with you and order the right workup. After your visit we provide a detailed superbill to submit for possible out-of-network reimbursement (varies by plan), and we accept HSA, FSA, and CareCredit.
"Why do I need a consult if my doctor already referred me?"
Your doctor's referral gets you to the right place, but Dr. Cruz still needs to do her own evaluation to build a plan that's specific to you — that's standard for any specialist referral, and it's what makes sure the plan actually fits your labs and history.
"It sounds expensive."
I'll be transparent about the cost once we've confirmed which service fits best — Dr. Cruz's team can walk you through exactly what's included, and we do offer CareCredit if you'd like to spread out payment.
5

Outcome, Next Steps & Referral Loop

You: Whenever you're ready, I can get you on Dr. Cruz's calendar, or you can book on our website. Kenneth, our patient care coordinator, will text you the intake packet and be your direct line.

📋 CRM Note (auto-generated)

Paste into the Referral pipeline in SymplastCRM. · Pricing shown for TRT only — confirm all other pricing with Dr. Cruz before quoting.
Call reminders
  • Confirm the referring provider's name and reason for referral before anything else — it sets the whole call.
  • Only TRT pricing is preloaded in this tool. Every other service needs pricing confirmed with Dr. Cruz before quoting.
  • If records weren't sent with the referral, flag it — request from the referring office before the visit.
  • Close the loop: plan a thank-you/update fax back to the referring provider.
  • Don't diagnose, dose, or promise results — that's Dr. Cruz's role.
  • Flag safety items but don't counsel on them.
Physician Referral Intake · A Service of My Wellness Physicians · mywellnessphysicians.com · 703-777-9355