Toenail Fungus

This package includes several visits. On the first visit, Dr Rienstra will examine you to be sure this treatment is appropriate for you. (If not, there is no charge.) If appropriate, he will give you a prescription for a medication you apply to the nail to treat your toenail fungus. You may need to have excess toenail removed by yourself or by a podiatrist.

You will return in three months for another examination. You will continue treatment. Most of our patients find that after six months their toenail fungus is greatly improved or eradicated. If in six months you are not experiencing that benefit, we will refund your payment for this service.

How it works

We will prescribe a compounded mixture of

· Terbinafine - a prescription anti-fungal medication

· oil of Melaleuca alternifolia - also known as Tea Tree Oil, a natural anti-fungal agent

· DMSO - also known as dimethylsulfoxide - a penetrating agent

We will instruct you to apply this medication to the toenail and to a 1/8th inch margin of skin adjacent to the toenail. You will apply this every day for six months or more.

The prescription will cost about $40 to $80 for the first few months, depending on the number of nails you are treating. A large toenail can take six months to grow out, so treatment will have to be continued for six months or more.

For nails that are too thick, we may prescribe a cream that you will apply daily for a couple of weeks to soften and remove the excessive nail.

What are the side-effects?

DMSO penetrates the skin, and can carry surface dirt and toxins in with it. If you accidentally mixed it with ink, you might permanently discolor the skin. If you mixed it with arsenic, you could carry the arsenic into your body. So you need to clean your feet before applying this to the skin. Discard the solution if anything contaminates it.

On occasion, people will find that the DMSO irritates the skin, causing it to turn red. In that case, you will need to apply the medication to the nail only.

Insurance Billing

We cannot give a refund once your insurance has been billed. Therefore your options are to obtain an insurance billing form from us at the first visit and forego the "No Cure - No Pay" proviso. There is no extra charge for this. As an alternative, once treatment is complete and you are satisfied, we will provide you with health insurance claim forms. You can complete these and send them to your insurance company. (We do not provide billing forms for anyone on Medicare, Washington Basic Health, or similar insurance.)

How does this compare to the oral drugs for toenail fungus?

The current "favorite" oral medication is terbinafine (brand name Lamisil®). When you consider the cost of the medication, the cost of lab work to monitor for side effects, and the cost of physician visits to monitor the treatment, the total cost is about $1000 for a course of treatment. Treatment is about 75% effective. For those for whom the treatment is effective, the fungus returns after an average of 900 days. Therefore, for each day of cure, the cost works out to about $1.23. (Not to mention the possibility of side effects, and time spent in physician visits, etc)

Our experience is that about 90% of our patients are happy with this topical treatment. The risk of side effects is less, the cost is less, and should the fungus begin to recur it should be a good deal easier to deal with when it is at its beginning stages.

What if this method does not work for me?

If this method does not produce satisfactory results, we will refund all or part of your payment as noted below.

Can I get a refund on the prescription cost if this does not help?

No. We can only refund the amount you pay us at this office.

Requirements
· This service is only for non-pregnant patients with no immune problems (such as HIV).
· You must be over 18 years of age (or at least sixteen years old if living independently.)
· You must not have any problems circulation or sensation in the feet.
· Because smoking impairs circulation and immune function, you qualify for only 50% of the full refund if you smoke.

Agreement

I understand side effects of treatment may be:

· Allergic reaction to the medication (uncommon)

· Irritation to skin if DMSO is applied to it.

· Discoloration of skin if DMSO is contaminated with any coloring agent.

· Any toxins on the skin where I apply the DMSO may be carried into the body.

I agree that payment will be refunded only if these conditions have been met.

· I return for repeat treatment in three months as scheduled by the clinic.

· That I am not satisfied with the treatment.

If my toenail fungus is almost gone at six months and I am satisfied that the treatment is effective (though not 100% so), I will accept this as a cure and exercise my option of getting a further refill on the medication. This is entirely up to me and I am entitled to a refund if I do not decide I wish a refill.

I understand Dr Rienstra may determine by his examination that I have some problem more complex than toenail fungus. In that case,

_____ I wish to terminate the No Cure - No Pay procedure with no diagnosis given.

_____ I wish Dr Rienstra to give me his diagnosis and treatment and will pay the usual office fee.



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Print name                                                        Date

3/27/04