Understanding Your 60-Minute New Patient Deep Dive
What happens in your first appointment, and why it looks nothing like traditional healthcare.
For most people, a doctor’s visit is 15 minutes, a prescription, and maybe a referral to see a specialist. You barely finish describing what’s wrong before the visit is over, and you leave with no real sense of what’s actually driving the problem.
That is not how we approach medicine.
We block out 60 minutes to cover all the bases and ensure that you are seen, heard, and understood. If we don't get to everything within 60 minutes, then I have no problem with running longer.
There's a lot to unpack when it comes to your initial appointment with us. Here's what to expect when you get started.
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Before this first appointment begins
Our work really starts before the first appointment itself.
By the time you sit down for the 60-minute new patient deep dive appointment, we have already moved through four pieces together, each designed to help identify and overcome the root cause so that you can get back to feeling your best.
1. Your free 15-minute intro call. On your free 15-minute intro call, we are already talking through the testing that might make sense for you. Even before I see your intake form, I will tell you the kinds of testing and panels I am thinking about based on what you tell me in this call.
2. Your intake form. Once you have joined the practice, your comprehensive intake form gives me the full backstory: all major current health concerns in order of the priority with which you want me to address them, your in-depth health history, labs from the last 12 months, and other critical information most doctors fail to consider. This information shapes everything that comes next.
3. Your initial functional lab testing. Right from the start, we're already ordering personalized functional lab testing to identify your root cause. What we order is built around your unique case. For most patients, that means a Quest Diagnostics panel for a fasted lab draw. From there, the testing follows wherever your concerns point. If we're doing a cardiovascular deep dive, you'll get a full panel of cardiovascular-specific markers. If it's a gut issue, we order testing for that. If your thyroid is in question, that can mean a complete thyroid panel: T3, T4, reverse T3, thyroid antibodies, and the nutrients your thyroid depends on. The same goes for hormone imbalances and autoimmune concerns, each of which gets its own targeted set of tests.
*Note: Since each test runs on its own timeline, this is also the part that determines the most appropriate date for your first appointment: depending on the panels we order, results take anywhere from about two to four weeks, with bloodwork coming back fastest and microbiome and hormone testing taking the longest.
4. Your Fast Track Action Plan. I don't want you sitting on your hands while lab results come in. So based on your presenting health concerns, I email you key recommendations you can start on right away. That way you are already making progress before we ever meet, and we are building momentum instead of letting time pass us by.
That's the groundwork.
By the time we begin the 60 minute new patient deep dive, your health history is in, your initial lab results are in, and you are already taking action, which is exactly what lets us go deep into helping you optimize your health right from the start.
Now to the actual 60 minute new patient deep dive itself.
What we actually cover in the 60 minutes
Here is roughly how the conversation flows. It is not rigid, and I move things around depending on what you need, but these are the pillars we are almost always working through.
Goals first
What would healthy look like to you a year from now? Which change would make the biggest improvement in your day-to-day life?
We focus on quick wins to get you moving, alongside the longer-term strategy of overcoming root causes.
How you want to get there
Some people want the "fastest" route and are open to medication. Others tell me up front that they do not want to add in twenty supplements and would rather work through diet and lifestyle. I want to know that early, because it shapes everything I recommend.
Your precise health history
What was your health like as a child? Any hospitalizations? Were you on a lot of antibiotics for recurrent infections? I am tracing the overall trajectory of your health, looking for the triggers that might have led to whatever you are dealing with now.
What you have already tried
A lot of people come to me having worked with other practitioners. So I want to understand how they attacked the issue: what testing was done, what you tried, what worked, what backfired, or what got you partway there.
That history saves us from revisiting dead ends.
Any specific red flags on your intake
This is where we go deep on the details. Let’s say your father had a stent. I want to know whether that is a true risk factor for you, or whether he was a smoker who was overweight and diabetic. Or maybe you have several mercury amalgams, and I am asking when those were placed and how that lines up with when your symptoms showed up. Or you mention you got food poisoning in Mexico, and I am connecting that to when your gut symptoms started.
We're aiming to get clarity on the triggers and the risk factors.
The lifestyle pillars
We go through diet (breakfast, lunch, dinner, and where I think you should nudge things), exercise, sleep, and stress. Sleep and stress come up almost every time, because they are such foundational pieces.
The recommendations are specific to you: if it is pre-diabetes, we talk blood sugar control; if it is cardiovascular risk, we talk about things like a portfolio diet, more legumes, more plant sterols, and the right kind of exercise for your situation.
Your lab results
This part usually takes at least 20 to 30 minutes on its own. I go through your results in depth, the normal, the abnormal, and the partially abnormal. Most of my patients want to understand the details, so unless you are feeling overwhelmed, I am going to walk you through what we are seeing and what it means.
Sometimes this is where a new diagnosis comes up that you did not know you had, like Hashimoto’s thyroiditis, where you may have known you had a thyroid issue but not that it was autoimmune.
Then, I lay out your real options: through diet and lifestyle, through supplementation, through medication, or some combination, and I will tell you what I would recommend.
When a separate 30-minute lab review is needed
Sometimes we have to split your new patient deep dive into two separate appointments.
If we do not have all your labs back by that first appointment, we'll have you schedule a separate 30-minute lab review once those results come in.
*Note: To be clear, there is no additional fee for this.
If we go into the deep dive with all your data and we just need to build and implement the plan, you will not need it. But, for example, if your main health concerns are female hormone-related and we are waiting on the DUTCH test, I would rather sit down with you again and go through those results properly rather than have you interpret them on your own.
What to expect after the appointment
After your 60-minute new patient deep dive, the plan goes into motion right away.
Prescriptions go out to your pharmacy, and if something calls for a compounding pharmacy, I will get you those details so you know exactly where to pick it up.
I curate your specific list of recommended supplements just as quickly on Fullscript. You will get an email notification to log in, where your list is already put together and waiting for you.
Then, within one to three business days, your detailed email summary follows.
This is everything we covered written up in one place: the reasoning behind your plan, any referrals or imaging orders, and anything I needed to research or clarify based on what you told me. You never have to worry about trying to hold it all in your head after the call.
From there, you continue putting it all into practice. If you have any questions about your care, you can email me or text me directly. Text is best for the quick questions and email for anything more detailed, and I usually get back to you within a day or two, sometimes up to three for the more detailed questions.
Moving into your quarterly follow-up appointment
We like to give the plan four to six weeks, preferably six, before we retest the values we are steering toward, so we can see how it is actually working for you.
From there, the next step is scheduling your quarterly follow-up and lab review, the appointment we set once those retests are back. That is where we review your data together, keep identifying the root-cause triggers behind what you are dealing with, track your progress, and adjust until your numbers move into your optimal range and you start feeling your best again.
That is the deep dive. Sixty minutes, your full history, your real labs, and a plan you understand, with me on the other end of a text the whole way through.
About the Doctor
Based in San Diego, Dr. Erez is a 5-star rated integrative medicine practitioner with over 5 years of experience running his own private practice and treating hundreds of patients. He is an Institute for Functional Medicine Certified Practitioner (IFMCP) and is board-certified by the American Board of Family Medicine.
A frequent medical source, he has contributed to publications including Everyday Health, Best Life Online, California Mobility, and Woman's World. Dr. Erez is most passionate about helping individuals identify the root causes of chronic disease and leverage evidence-based interventions to reach their version of optimal health.
Frequently asked questions
If you have a PPO plan, we run the majority of your lab testing through your insurance, so most of it is covered, especially that first comprehensive set of labs before your first appointment.
For specialty tests we know insurance won't cover, we'll run those as cash pay, but at a discounted rate through Quest or LabCorp to keep it reasonable. Cash labs for a standard comprehensive panel typically run $300 to $500. Very specialized testing for a specific issue can run a bit higher, but that range covers most patients.
You can always check the CPT codes ahead of time if you want to confirm coverage. Once in a while an insurer denies something and we send in chart notes, and occasionally they still won't cover it, so we switch that lab to cash pay, generally landing in that $300 to $500 range. That doesn't happen often.
It depends on the test. For most, you'll get an email from the company letting you know I've ordered it for you, and you just finish the process.
- Microbiome test: you pay up front, then the kit ships to you.
- DUTCH test: our clinical team orders it, the kit arrives at your house, and you pay after it's processed (no upfront purchase).
- SIBO breath test: we order it, the kit arrives, and again there's no upfront purchase.
Once it arrives, take it when you're able, following any timing rules for that test (for example, the DUTCH test is timed to your cycle).
Our clinical team sends your results as soon as they come in, so keep an eye out for that email. We then go over and interpret them together at your scheduled appointment. "Results received" isn't the same as "results reviewed," and the appointment is where the actual interpretation happens.
The exception is anything acute. I'm always watching results, and if something is really off the wall, I'll reach out directly to address it or order an additional test.
You're welcome to email clinicalteam@drerez.com if you want to check on your results. Usually the answer is simply that they're not back yet, but if it's been a while and you still haven't heard, that's the place to ask.
If something clear shows up in your results, yes. For example, if your labs point to Hashimoto's thyroiditis or a breath test confirms SIBO, I will tell you exactly what it is, what it means, and the different ways we can approach it. I would rather you understand the name and the why than have you walk away with a label you do not understand.
Text is best for quick questions, like whether to fast before a blood draw or pause a supplement before a test. Email is better for anything more detailed. I usually get back to you within a day or two, sometimes up to three for the more involved questions.
We'll go through all your supplements one by one and decide what to keep and what to swap for a higher-quality version. Most of what I recommend runs through Fullscript, an online dispensary with a lot of doctor brands plus some you'd find elsewhere.
I give specific brand recommendations because quality really does matter: one brand isn't always equivalent to another. So I don't recommend grabbing something off the shelf at Sprouts that just looks similar. That said, if you find the exact same brand and product cheaper somewhere else, go for it. And there's a patient discount built into Fullscript.
Yes. After each visit you'll get an appointment summary email plus a supplement plan PDF. It's detailed, so you don't need to take notes during your visit. (Visits aren't recorded.) These usually go out within one to three days. If you haven't gotten yours by then, feel free to ping me, since things are occasionally delayed.
