No insurance is accepted for visits. You will be asked for your insurance information needed for labs, referrals, etc. Superbills can be provided after each visit. I hope to accept some insurances in the near future.

Yes, I have experience with remote HEDS diagnosis. I obtain a very detailed history, and the diagnostic checklist can be satisfactorily completed via telehealth. There is a lot more to consider other than just the Beighton score.

• Submit an inquiry and we can figure it out together. We could also do a free 10 minute phone or zoom call to see if you think we would be a good fit. We could also try to figure out a unique level of service that works best for your needs.

• I will order genetic testing when there are red flags or suspicions for subtypes or related conditions of EDS other than HEDS. At this time, HEDS is a clinical diagnosis, and no genetic test is available to confirm this diagnosis. Labwork would be run through your insurance, and your insurance may require you to pay some or all out of pocket. Invitae, which is the lab that runs the EDS genetic testing has now merged with LabCorp, and they will no longer give estimates about potential out-of-pocket expenses. If I do order genetic testing, I try my hardest to get expenses covered. If you book a "coaching" appointment, I am not able to directly order any testing, but I could make a recommendation in writing for you to take to your PCP, who would have to write the order.

• No, due to telehealth regulations I am not able at this time. I do not judge or look differently at any patient that needs to be on stronger, controlled medications for pain or anxiety. I could work with your pain management provider or psychiatrist or PCP who manages your controlled substance medications.

NO! I use clinical symptoms and response to treatment and treat based on a combination of factors. I listen to YOU, not just lab values. Recently, experts in the field have noted that most people with MCAS do NOT have chronically elevated Tryptase levels, unless they have a genetic variant called Hereditary Familial Hypertryptasemia, which is managed the same as MCAS. The labs used to confirm MCAS are challenging to obtain and run accurately and often add no value to the diagnosis and treatment of your MCAS symptoms. I use an individualized approach to decide which, if any, tests are needed to support diagnosis and management.

• NO! I use results from Nasa lean tests and symptom tracking done at home to diagnose POTS or orthostatic intolerance, and I treat symptoms, not numbers. You still may have symptoms, that vary from day to day, even if you do not meet the strict criteria for POTS during a single tilt table test. There are certain indications where I would refer you for a tilt table test, but that is based on individual presentation. There was a study done that showed that patients with EDS often did not reach the cut-off numbers needed to officially diagnose POTS on tilt table testing, often missing it by only a few points. BUT EDS patients with borderline numbers were more symptomatic than non-EDS patients with POTS who had higher heartrate changes during testing.

• I will offer deeply discounted or pro-bono services, to aid with obtaining an HEDS diagnosis, for a limited number of meetings free of charge, to educate more people about HEDS and to help answer questions. Please contact me if interested.

• I live in a rural area in North Carolina, and telehealth allows me to reach more people. I also realize it can be challenging for my patients to travel. I am living with EDS, and it can be difficult for me to work long days, standing up in a busy office full of viruses and mast cell triggers. Each new day as a zebra is full of surprises!! I found that I am able to establish excellent, genuine patient relationships through telehealth. Some parts of an exam may be better in person, but overall, the benefits of telehealth outweigh the barriers we zebras face. I will always consider offering in-person visits in the future, to patients willing to travel, if there is enough interest.

• NO! HEDS is currently a clinical diagnosis, with no blood tests available to support the diagnosis. The diagnostic check list can be performed by any knowledgeable provider. Right now, there are very long wait lists to see geneticists familiar with HEDS, and many are turning away HEDS patients, and only seeing the EDS subtypes like Vascular or Classical EDS. Rheumatologists are also turning away hypermobile patients seeking a diagnosis. Thankfully there are more providers choosing to learn about EDS. A silver lining to having myself and having 3 children with HEDS has been being able to gain expertise in hypermobility and comorbidities, as well as meeting so many awesome zebras, I truly love this patient population!! I have seen with my own eyes some of the unbelievable symptoms and struggles zebras face, and I promise, I always believe what my patients are going through!

Telehealth laws require that physicians must be licensed in the state where the patient has the telehealth visit. You could literally drive across the state border and sit in your car or at a friend's house and do the telehealth visit. It does not matter if your home address and your pharmacy are in a state where I am not licensed, it only matters where you are for the appointment. If there is enough interest in certain states where I am not yet licensed, I will consider becoming licensed there. Coaching is a way to get around the strict telehealth laws and still offer patients appointments, but I cannot prescribe or place orders, including genetic testing.