What Your First 90 Days Look Like

Most patients tell us the first 90 days are the moment the membership starts to feel like a different kind of medicine. This page is the map. So you know what is coming, when, and what your part is.

Week 1 - Orientation

You just joined. The goal of week 1 is simple: get the practice oriented to you, and get you oriented to the practice. On your side:

• Send whatever records you have to records@fishtownmedicine.com: recent labs, imaging reports, specialist notes, OB/GYN history, hospital records, anything. We do not need it organized. We organize it.
• Save Dr. Ash's number for texting. You will see when to use it inside the practice flow.

On our side:

• We confirm you and read whatever you sent before our first real conversation.
• We schedule the records visit (the next step), usually within the next 2 weeks.
• A short orientation email covers: when to text, when to call, urgent versus routine messaging, and what is in versus out of scope.

There is no test. No pressure. We are setting up the relationship so the medicine can be different.

Weeks 2 to 3 - The records visit

Your first real conversation as a member. This is the visit that is not like a normal doctor's visit.

• 60 to 120 minutes, no timer. We finish when you and I are 100% on the same page about what has been done, what was found, and what we are actually looking at.
• Records read together. Prior labs, imaging, specialist notes, hospital records. Most patients tell us this is the first time a physician has read their whole story in one sitting.
• Goals named in plain English. What do you want different in 6 months? In a year? The visit ends with that question on the table, not vague reassurance.

By the end of the visit you have a working list of what we are going to look at next, and labs ordered specifically for your picture.

Weeks 3 to 6 - Advanced labs and the deep dive

The labs we order are not a default panel. They are chosen for your specific picture. Standard advanced markers we run for most members:

• ApoB (the lipoprotein count that predicts heart events better than LDL).
• Lp(a) (genetic, run once, drives a meaningful slice of early heart disease).
• Fasting insulin (moves years before A1c).
• hs-CRP (systemic inflammation).
• Full thyroid (TSH, free T4, free T3, TPO antibodies).
• Vitamin D, B12, ferritin (the boring deficiencies that quietly run mood, energy, recovery).
• Comprehensive metabolic panel and complete blood count (the foundation).
• Hormones when clinically relevant (testosterone with SHBG, full female-cycle panels in perimenopause).

Labs are usually drawn at a partner lab near you. Results come back in 7 to 10 days. We message you when they are in. Then we sit down again. Same way. No timer. We read the numbers together. The plan that comes out of that conversation is the working document for your next year.

Weeks 7 to 12 - Execution

This is where the work becomes care. The first 6 weeks build the picture; the next 6 turn it into action. On our side:

• Specialist referrals if needed, with a clinical briefing so the first specialist visit is not wasted on history.
• Medication changes coordinated with whoever prescribes them.
• Lifestyle plan: what specific changes to sleep, training, nutrition, and risk reduction we are prioritizing first.
• A 30-day check-in to see what is working, what is not, and what to tune.

On your side:

• Doing the parts of the plan that need you to do them (labs you have to schedule, a sleep change, a strength program, a habit change).
• Texting Dr. Ash directly when something flips, something is unclear, or you want a sanity check.
• Showing up for the re-tests we plan together.

By day 90 you have a written plan you can hold, a real understanding of your risk picture, and a relationship with a physician who knows you.

What the 90-day arc costs

The 90-day arc is included in membership; there is no separate onboarding fee. Membership runs $250 per month, $685 per quarter (roughly one month free over the year), or $2,500 per year (roughly two months free). HSA / FSA dollars may apply; confirm with your plan administrator. Labs are billed separately at insurance or cash, whichever is cheaper for you. We help you decide which path is cheaper before anything significant is ordered.

What you should expect to feel by day 90

This is honest. Most patients report some version of:

• Clarity. You know what your risk picture looks like and what the plan is. The vague worry becomes a specific list.
• Access that is real. You have used the direct text or video at least once, and it worked. The membership has stopped feeling abstract.
• A relationship. Your doctor knows your story across more than one visit. That continuity is the thing the system has stopped offering, and the thing the membership is buying.

Patients who do not feel that by day 90 usually tell us in the 30 or 60 day check-in, and we tune. The plan is not delivered as a finished document; it adjusts.

What if I miss a window?

Life happens. Labs slide. Travel happens. Work flares. The expected timeline in this page is the target; the practice is not built to punish you for missing it. The follow-through is what matters, and we keep nudging gently until the plan is loaded.

How to start

Twenty minutes on the phone with Dr. Ash. If it is a fit, you join and the records visit is the next thing on the calendar. If it is not, we will say so.