Terms and Conditions

Bernadette Spencer Family Health NP PLLC · d/b/a Raven Metabolic & Hormone Health

Section 1: About This Agreement

These Terms and Conditions ("Terms") govern the relationship between Bernadette Spencer Family Health NP PLLC, doing business as Raven Metabolic & Hormone Health ("the Practice," "we," "us," or "our"), and any individual ("Patient," "you," or "your") who enrolls in the Raven Functional Medicine Program ("the Program").

These Terms are a binding legal agreement. They should be read in conjunction with the following documents, which are provided separately at onboarding:

• HIPAA Notice of Privacy Practices — governing the use and protection of your Protected Health Information
• Telehealth Informed Consent — governing the delivery of clinical services via telehealth technology, as required under New York Public Health Law Article 29-G

Submission of an inquiry through this website does not constitute enrollment and does not establish a provider-patient relationship. A provider-patient relationship is established only upon completion of a discovery call, execution of a signed Enrollment Agreement, and receipt of the required deposit or paid-in-full payment.

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Section 2: Scope of Services & Medical Disclaimer

2.1 Nature of Services

Raven Metabolic & Hormone Health provides an individualized functional medicine program encompassing advanced functional laboratory assessment, HPT/HPA/HPG axis evaluation, individualized clinical protocol design, nutritional and lifestyle guidance, and ongoing remote clinical support. Services are delivered exclusively via telehealth by Bernadette Spencer, RN, MSN, FNP-C, FMACP, a Family Nurse Practitioner licensed in New York State.

2.2 What This Program Is Not

This Program does not constitute primary care, emergency medical care, or acute medical management. The Practice does not manage prescription medications, adjust existing pharmaceutical regimens, or provide urgent or emergent clinical services. Laboratory findings generated through this Program are intended to inform a comprehensive functional medicine assessment and are not intended to replace the diagnostic or therapeutic decisions of the Patient's Primary Care Physician or other treating providers.

2.3 Primary Care Physician Requirement

Enrollment in this Program requires that the Patient maintain an active relationship with a licensed Primary Care Physician ("PCP") or appropriate medical specialist throughout the entire duration of the Program. The Patient agrees to consult their PCP before making any changes to prescription medications, medical dosages, or existing clinical treatments based on information received through this Program.

2.4 Not a Substitute for Emergency Care

This Program does not provide emergency medical services. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room immediately. Do not use this Program's communication channels to report a medical emergency.

2.5 Eligibility Requirements

Enrollment in this Program is available exclusively to individuals who meet all of the following criteria:

• Age: 18 years of age or older
• Geographic: Currently residing in and receiving services within New York State
• Primary Care: Currently maintaining an active relationship with a licensed PCP or appropriate medical specialist
• Psychiatric Stability: Not currently experiencing an acute psychiatric crisis, including but not limited to active suicidal ideation, active psychosis, severe untreated major depressive disorder, active substance use disorder, or any condition requiring inpatient or intensive outpatient psychiatric care

This Program is available exclusively to adults 18 years of age or older. This restriction is absolute and admits no exceptions, including parental or guardian consent. This restriction exists because metabolic and body composition programs carry documented clinical risks for adolescent populations, including the potential exacerbation or triggering of disordered eating patterns. Raven Metabolic & Hormone Health does not provide services to minors under any circumstances.

This Program is not appropriate for individuals currently experiencing an acute psychiatric crisis, including but not limited to active suicidal ideation, active psychosis, severe untreated major depressive disorder, active substance use disorder, or any condition requiring inpatient or intensive outpatient psychiatric care. Enrollment in this Program does not substitute for psychiatric or psychological treatment.

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Section 3: Program Structure

3.1 Individualized Clinical Framework

This Program is built around a systems-based assessment of the patient's unique hormonal architecture across three primary axes: HPT (thyroid), HPA (adrenal), and HPG (reproductive). Each patient presents a distinct pattern across these axes, which determines the individualized sequence and pacing of clinical intervention. The Program is structured to address each axis in the order of its clinical priority for that patient — primary correction first, secondary second, tertiary where indicated — with all clinical decisions guided by laboratory findings and the patient's biological response rather than a fixed calendar timeline.

3.2 Program Duration

The base program term is 13 months. Because the body does not heal on a calendar schedule, the Program may be extended up to a maximum of 18 months at no additional charge to the Patient. Extension beyond 13 months is determined by clinical need and mutual agreement between provider and patient. All clinical services provided during the extension period — including additional visits and laboratory panels — are included within the original program fee.

3.3 Visit Structure & Laboratory Schedule

The Program includes a minimum of 15 clinical visits over the base term, structured as follows:

• Initial 90-minute consultation — prior to comprehensive report delivery, including baseline laboratory order
• Comprehensive report delivery visit — review of baseline laboratory findings and individualized program design
• Twelve 30-minute clinical visits — at weeks 1, 3, 5, 7, 9, 13, 17, 21, 29, 37, 43, and 52
• 90-minute closing visit — at approximately week 55 or 56

Laboratory panels are ordered and reviewed on the following schedule:

• Baseline panel: Ordered prior to the comprehensive report delivery visit
• 3-month panel: Ordered at week 9, reviewed at week 13
• 6-month panel: Ordered at week 21, reviewed at week 29
• 9-month panel: Ordered at week 33, reviewed at week 37
• Optional 12-month panel: Ordered at week 45, reviewed at week 52, at the discretion of both provider and patient

The visit structure and laboratory schedule described above represent the baseline minimum. Individual patients may require additional visits and laboratory panels beyond this baseline based on their clinical response and the pace of their hormonal correction. All such additional services within the 18-month maximum are included within the original program fee.

3.4 Delivery

All services are delivered via telehealth using HIPAA-compliant technology platforms. The Patient is responsible for maintaining reliable internet access and appropriate technology to participate in scheduled visits. The Practice is not responsible for service interruptions caused by the Patient's technology limitations.

3.5 Missed Appointments

Missed appointments cancelled with less than 24 hours notice may be forfeited at the Practice's discretion.

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Section 4: Fees & Payment

4.1 Program Fees

The Program is offered under two payment structures:

Both payment structures provide access to the full Program including any clinically indicated extension up to 18 months. No additional fees are charged for program extensions, additional visits, or additional laboratory panels within the 18-month maximum.

4.2 Fixed-Term Commitment

The Monthly Payment Plan constitutes a fixed-term contractual commitment. It is not a month-to-month subscription. Monthly payments cannot be paused or stopped unilaterally by the Patient except as provided under the Hardship Hold provision in Section 7 of these Terms.

4.3 Payment Processing

The Patient is responsible for maintaining current and valid payment information on file throughout the Program term.

4.4 HSA and FSA

Patients wishing to use Health Savings Account (HSA) or Flexible Spending Account (FSA) funds toward Program fees should consult their HSA/FSA administrator and a qualified tax advisor to confirm eligibility prior to enrollment. The Practice makes no representations regarding the tax treatment of Program fees and does not provide tax advice.

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Section 5: Failed Payment Protocol

5.1 Notice of Failed Payment

If a scheduled monthly installment fails to process on its designated billing date, the Practice will issue an automated Notice of Default via electronic mail or patient portal on the same day (Day 1).

5.2 Immediate Service Pause

The Patient's active access to the Program — including scheduling of clinical visits, portal messaging, and release of new clinical materials — will be paused immediately upon a failed payment. The Patient may continue to access previously delivered materials during the grace period.

5.3 Fourteen-Day Grace Period

The Patient is granted a grace period of fourteen (14) calendar days from the initial failed billing date to update their payment method and clear the outstanding balance.

5.4 Account Suspension

If the payment remains unresolved after the 14-day grace period, a $35.00 administrative fee will be applied to the account. Reinstatement after Day 14 requires payment of both the outstanding installment and the administrative fee before access is restored.

5.5 Program Termination for Non-Payment

If a failed payment remains unresolved for thirty (30) calendar days from the original due date, the Patient will be considered in material breach of contract. The Practice will formally terminate the Patient's program enrollment and permanently revoke portal access. Upon termination for non-payment, the Practice retains all amounts paid to date. No further payments will be collected. No refund will be issued. The Patient has no further financial obligation to the Practice beyond amounts already paid.

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Section 6: Refund & Cancellation Policy

6.1 Pre-Clinical Cancellation

If a Patient requests cancellation prior to their first clinical visit, a full refund will be issued regardless of payment structure. No administrative fee applies.

6.2 Post-First Visit — Prior to Initial Report Delivery

If a Patient requests cancellation after their first clinical visit but before the initial clinical report has been delivered:

• Paid in Full: 75% refund of the total amount paid
• Monthly Payment Plan: The deposit is non-refundable. No further monthly payments will be collected. No refund of amounts paid beyond the deposit.

6.3 Post-Report Delivery

The delivery of the initial clinical report represents the completion of the highest-value clinical work in the Program. Once the initial report has been delivered to the Patient, the following applies without exception: Paid in Full — maximum refund of 50% of the total amount paid. Monthly Payment Plan — the deposit is non-refundable, a minimum of two total months of payment must have been collected before cancellation is permitted, and no refund of amounts paid applies.

6.4 Post-Phase 2 Commencement

No refund is available after the second phase of clinical intervention has commenced under any payment structure.

6.5 Non-Payment Termination

No refund applies to program termination resulting from non-payment as described in Section 5.5.

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Section 7: Hardship Hold Policy

7.1 Qualifying Events

A formal Program Hold may be requested in the event of a serious personal medical diagnosis requiring treatment that precludes Program participation, the death of an immediate family member, or a documented family medical emergency of significant magnitude.

7.2 Request Requirements

To qualify for a Program Hold, the Patient must submit a written Hardship Hold Request within 30 days of the qualifying event, accompanied by supporting documentation. Acceptable documentation includes a signed letter from a licensed physician or mental health provider, a death certificate or obituary, hospital discharge paperwork or emergency room records, or signed legal documentation in the case of a qualifying legal or family emergency. Documentation will be held in strict confidence in accordance with HIPAA. The Practice reserves the sole discretion to approve or deny requests.

7.3 Hold Status

Upon approval, monthly payments are immediately suspended, the Patient's clinical file remains active, no additional fees are applied, and the Patient retains access to previously delivered materials.

7.4 The Program Clock During a Hold

The Program clock pauses for the duration of an approved Hold. The 18-month maximum program duration is measured in active program time only and does not include any approved Hold period. Upon resumption, the Patient's remaining program time is calculated from the point at which the Hold began, not from the original enrollment date. A patient who held at month 6 and returns at any point resumes with the full remaining program time intact.

7.5 Resumption — Clinical Continuity Track

Upon resumption, the provider will conduct a laboratory assessment to determine the patient's current clinical status. If prior clinical progress is substantially intact, the Program resumes at the point of Hold. Monthly payment plan patients resume payments from the point at which payments were suspended. If 6 or more months of payments had been collected prior to the Hold, the Patient resumes at no additional charge for the remaining balance of the original agreement. If fewer than 6 months of payments had been collected, monthly payments resume at the original rate. Paid in Full patients simply resume with no financial adjustment. The Practice will restore full access within 30 days of written notice of intent to resume.

7.6 Resumption — Clinical Reset Track

If the provider determines upon laboratory reassessment that the hardship event has materially disrupted prior clinical progress — as significant stress events are clinically recognized to do — the Program may be restarted from the initial phase at the provider's clinical discretion. A clinical reset does not alter the patient's financial position. Monthly payment plan patients continue payments from the point at which payments were suspended — the financial clock does not reset, only the clinical one. They are not charged twice for the same clinical ground. Paid in Full patients resume without any financial adjustment.

7.7 Unable to Resume — Paid in Full Refund

If a Paid in Full patient with an approved Hardship Hold is genuinely unable to resume the Program, a pro-rated refund will be calculated based on complete unused program months remaining. For purposes of this calculation, any month in which the patient received clinical services — regardless of how many visits or weeks occurred within that month — is counted as a used month in full. The refund is calculated by dividing the number of complete unused months by thirteen (13), multiplied by the original program fee of $4,497.00. No refund is issued for any month in which clinical services were rendered, even partially.

Example: A patient who completed any portion of month 6 is credited for 6 used months. The refund would be calculated as 7 ÷ 13 × $4,497.00 = $2,421.92.

7.8 Maximum Hold Duration

A Program Hold may not exceed twelve (12) consecutive months. If the Patient has not provided written notice of intent to resume within 12 months of the Hold commencement date, the Program will be closed. For monthly payment plan patients, no further payments will be collected and no refund of amounts already paid will be issued. For Paid in Full patients, the pro-rated refund calculation described in Section 7.7 will be applied at the point of Program closure.

7.9 Ineligibility for Hold

A Hardship Hold is not available for general dissatisfaction with the Program, financial hardship unrelated to a qualifying event, or voluntary withdrawal from care. Patients who voluntarily withdraw and subsequently request reinstatement must submit a new inquiry through the standard process.

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Section 8: Compassionate Termination

8.1 Practice-Initiated Termination for Patient Safety

In the event that program participation is terminated by the Practice for patient safety reasons — including but not limited to the emergence of acute psychiatric conditions, medical instability, or other circumstances that render continued participation clinically inappropriate — the following applies: all amounts paid beyond the initial deposit will be refunded in full regardless of program phase; the deposit of $497.00 is retained; no early termination fee applies; and the Patient will receive a written clinical summary and appropriate referral recommendations.

This provision exists because Raven Metabolic & Hormone Health recognizes that health circumstances change, and that a patient requiring a higher level of care should not face financial penalty for doing so.

8.2 Psychiatric Safety

This Program is not appropriate for individuals currently experiencing an acute psychiatric crisis. The Practice reserves the right to suspend or terminate Program access if a Patient's psychiatric status changes in a manner that makes continued participation unsafe or inappropriate. Compassionate termination terms apply in such circumstances.

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Section 9: Intellectual Property

9.1 The Raven Brief

The Raven Brief is a clinical publication series authored by Bernadette Spencer, RN, MSN, FNP-C, FMACP and published under Raven Metabolic & Hormone Health. All volumes are protected by United States copyright law. The Raven Brief is made available for personal and educational use only. Redistribution, republication, resale, or commercial use without written permission is prohibited. Practitioners who receive complimentary copies may share individual volumes with patients or colleagues for non-commercial educational purposes with attribution.

9.2 No Provider-Patient Relationship via Publication

Reading or downloading any volume of The Raven Brief does not establish a provider-patient relationship. The content is educational in nature and does not constitute individualized medical advice. Readers should consult their own licensed healthcare provider before making any clinical or treatment decisions based on information contained in The Raven Brief.

9.3 Patient Clinical Report

The individualized clinical report delivered to each patient is prepared specifically for that patient's care and is protected under copyright. It may not be reproduced, distributed, or used for any commercial purpose. Patients may share their report with their own healthcare providers for the purposes of coordinating care.

9.4 Website Content

All content on ravenmhh.com is the intellectual property of Bernadette Spencer Family Health NP PLLC and is protected by applicable copyright and intellectual property law. Unauthorized reproduction or use of website content is prohibited.

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Section 10: Chargeback Policy

Filing a formal chargeback or payment dispute with a bank or credit card processor in a manner inconsistent with the refund and cancellation terms outlined in Section 6 of these Terms constitutes a material breach of this agreement. Upon receipt of a chargeback notice, the Practice reserves the right to immediately suspend portal access and provide the Patient's signed enrollment agreement and proof of services rendered to the payment processor as part of the dispute resolution process.

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Section 11: Governing Law & Dispute Resolution

These Terms are governed by the laws of the State of New York without regard to its conflict of law provisions. Any dispute arising under these Terms shall first be submitted to good-faith negotiation between the parties. If negotiation does not resolve the dispute within 30 days, the parties agree to submit to binding arbitration in Wyoming County, New York, under the rules of the American Arbitration Association. Nothing in this section prevents either party from seeking injunctive relief in a court of competent jurisdiction where necessary to prevent irreparable harm.

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Section 12: Changes to These Terms

The Practice reserves the right to update these Terms at any time. Material changes will be communicated to enrolled Patients via the email address on file at least 30 days prior to taking effect. Continued participation in the Program following notice of changes constitutes acceptance of the revised Terms. Changes do not apply retroactively to the payment structure or refund terms governing a Patient's existing enrollment agreement.

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Section 13: Contact

Questions regarding these Terms should be directed to:

These Terms and Conditions were last reviewed and updated: June 2026