Onboarding at Fishtown Medicine follows one shared task list, visible to you and Dr. Ash in your portal: set up Ultralight and sign two consents, select your plan, get your records in, draw your labs, then meet for the deep dive where your story and numbers are read together. After that comes your written plan and the 30, 60, and 90-day check-ins. You always see exactly where you are and what is next.
TL;DR: Onboarding is simple and predictable. You set up the Ultralight app and sign two consents, choose your plan, get your records in and your labs drawn, then meet Dr. Ash for the deep dive where your full story and numbers are read together with no timer. From there you get a written plan and a steady rhythm of check-ins through your first 90 days. At every step you know what is happening and what comes next.
Table of Contents
- What are the steps to get started?
- What happens in your first week?
- How do your records and labs come together?
- What is the deep dive visit?
- What happens in the first 90 days?
- How Fishtown Medicine approaches onboarding
- Key Takeaways
- Common Questions
- Deep Questions
What are the steps to get started?
Getting started follows a clear roadmap. Each step has its place, and once you join you can track your progress in the Ultralight app, so onboarding never feels like a black box. Here is the full arc, in order:
Get connected
- Intake completed. A short background so Dr. Ash knows your story before you ever talk.
- Consent signed. Two forms inside Ultralight: a consent to treat (so Dr. Ash can care for you) and a consent to coordinate care (so we can gather records and work with your other doctors, labs, and specialists on your behalf).
- Membership or package selected. The plan you are starting with, so your scheduling and messaging match what you signed up for.
Get your picture together 4. Previous records uploaded or requested. You share what you have, or you ask us to pull them for you once the coordinate-care consent is signed. 5. Labs drawn. Ordered after we talk, not before, so every marker is chosen for your specific picture.
The deep work 6. Deep dive visit. Your records and your story, read together, with no timer. This step opens up once your consent and plan are set and your labs and records are in. 7. Plan in hand, treatments set up. A written plan you can hold, with the first treatments and referrals put in motion.
The follow-through 8. 30-day check-in. What is working, what is not, what to tune. 9. 60-day check-in. Steady adjustment as the plan takes hold. 10. 90-day check-in. Results read together, the plan recalibrated for the year.
Each step has its own small status where it matters. Records can be shared, marked as none to share, requested from your old providers, or received. Labs move from ordered, to a scheduled draw, to drawn. You never have to guess what state something is in.
What happens in your first week?
Your first week is about getting connected, and it maps to the first three steps on the list. The moment you join, your direct line to the practice gets set up.
- Ultralight invite. An email with your unique link to download the Ultralight app. Ultralight is your hub for secure messaging, file sharing, scheduling, and video visits. The invite comes from your welcome email; if you do not see it, check spam.
- Two consents. Inside Ultralight you sign your consent to treat and your consent to coordinate care. The coordinate-care form is the one that lets us request your records on your behalf, so signing it early saves you the most time later.
- Your plan. Your membership or package is set, so visits and messaging line up with what you chose. You can change plans later in one click, with no fee either way.
A quick "Hello" message in Ultralight confirms your secure channel is live and tells Dr. Ash you are in.
How do your records and labs come together?
Your records and labs are steps four and five, and they are what make the deep dive worth having. We get your history under one roof so your first real conversation is about you, not about chasing paperwork.
Records can come in whichever way is easiest, and our records guide walks through each:
- Let us pull them. Once your coordinate-care consent is signed, message us where your records live (the practice, hospital, or system) and our team requests them for you.
- Portal export. Penn, Jefferson, Temple, Mainline, and Cooper all run on Epic MyChart. Open the menu, go to Sharing Hub, choose "Share with my healthcare provider," download the bundle, and attach it in Ultralight.
- Paper records. Scan a stack into one combined PDF with your phone and upload it in Ultralight.
Wearable data, if you use an Apple Watch, Oura, Whoop, or Garmin, gives Dr. Ash your baseline sleep, recovery, and heart rate trends. The more he can see, the deeper the first conversation goes.
Labs are ordered after we talk, not before. If you have insurance, you tell us whether to run labs through your deductible or pay cash, since cash is usually cheaper unless you are close to meeting your deductible. Imaging and referrals always route through your insurance. Most LabCorp and Quest sites around Philadelphia open by 7 a.m.
What is the deep dive visit?
The deep dive is step six, and it is the visit that is not like a normal doctor's visit. It opens up on your checklist once your consent and plan are set and your labs and records are in, so the conversation can go through real information.
- 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, and your own story, in one sitting. Most patients tell us this is the first time a physician has read their whole picture at once.
- Goals named. What you want different in 6 months and in a year, on the table, not vague reassurance.
You leave the deep dive with a working list and, soon after, a written plan. That is step seven on the list: plan in hand, treatments and referrals set up.
What happens in the first 90 days?
The first 90 days are where the picture becomes care, and they are the last four steps on your list. The early steps build the picture; the next stretch turns it into action and keeps tuning it.
- Plan in hand. A written plan you can hold, with lifestyle priorities, medication changes coordinated with whoever prescribes them, and any specialist referrals sent with a clinical briefing so the first visit is not wasted on history.
- 30-day check-in. We look at what is working, what is not, and what to adjust.
- 60-day check-in. Steady follow-through as the plan settles in.
- 90-day check-in. Re-tests on the markers that matter, read together, and the plan recalibrated for the year ahead.
By day 90, most patients describe three things: clarity about their risk picture and the plan, access that feels real because they have used the direct messaging at least once and it worked, and a relationship with a physician who knows their story across more than one visit.
Life happens, and the dates can slide. The roadmap is the target, not a deadline. If a window slips, we keep nudging gently until the plan is loaded. The follow-through is what matters.
How Fishtown Medicine approaches onboarding
In my practice, onboarding is built so nothing gets lost between "you joined" and "we have a plan." You can follow your progress in the app, and we order labs after the deep dive, not before, so every marker is chosen for your specific picture rather than a default panel. If you are in the Philadelphia area and want a physician who reads your whole story before the first visit, book an intro call with Fishtown Medicine.
Your onboarding checklist
The first steps, in plain order.
- Set up Ultralight. Download the app from your invite email and send a "Hello" to confirm your channel is live.
- Sign both consents. Consent to treat and consent to coordinate care, so we can care for you and gather your history.
- Get records moving. Share what you have, or ask us to pull them. Add wearable access if you use a device.
- Draw your labs. Once Dr. Ash orders them, schedule your draw and tell us your deductible-or-cash preference.
- Book your deep dive. It unlocks once your labs and records are in. Then the plan and the 30, 60, and 90-day check-ins follow.
Key Takeaways
- Onboarding runs on one shared task list that you and Dr. Ash both see in your portal, so you always know the next step.
- The first week is set up Ultralight, sign two consents, and confirm your plan; the coordinate-care consent is what lets us pull your records for you.
- Labs are ordered after the deep dive conversation, not before, so every test fits your specific picture, and you choose deductible or cash-pay for them.
- The deep dive is 60 to 120 minutes with no timer, and it unlocks once your consent, plan, labs, and records are in.
- The first 90 days end with a written plan and check-ins at 30, 60, and 90 days; slipped windows are fine, the follow-through is what matters.
Scientific References
- Bodenheimer T, Pham HH. Primary Care: Current Problems and Proposed Solutions. Health Aff (Millwood). 2010;29(5):799-805.
- Sinsky CA, et al. Allocation of Physician Time in Ambulatory Practice. Ann Intern Med. 2016;165(11):753-760.
- Ostbye T, et al. Is There Time for Management of Patients With Chronic Diseases in Primary Care? Ann Fam Med. 2005;3(3):209-214.
Dr. Ash is a board-certified internal medicine physician specializing in preventive medicine and healthspan optimization at Fishtown Medicine in Philadelphia.
Frequently Asked Questions
Common Questions
Deep-Dive Questions
Ready when you are
Dr. Ash reads every intake himself, and answers questions personally - usually within a few hours.
