What if I have a medical question before my first visit?

Yes, you can message us right away. Once your Ultralight app is linked, you can send questions immediately. If you have an [urgent need](/about/emergency-care-guide), we can often triage it before your formal diagnostic session.

Can I add my spouse later?

Yes, you can add family members to your membership at any time. We recommend doing so during the first week so you lock in our partner and family rate from the start.

Do I need to be a Philadelphia resident to join?

No, you do not need to live in Philly. Most of our care happens through video and messaging, and we are licensed in many states. We will confirm coverage during your intro call.

What devices and apps do I need?

You need a smartphone (iPhone or Android) to run the Ultralight app. A wearable like an Apple Watch, Oura ring, or Whoop is optional but helpful. A computer with a webcam is useful for longer video consults.

How long does the record transfer actually take?

Record transfers usually take 5 to 14 days, depending on the prior health system. Penn and Jefferson are typically faster; older paper records can take longer. We start the request on day two so it runs in the background.

Will I have to repeat all my labs?

You will not repeat labs unnecessarily. We use any recent labs (within 6 months) when possible. If we want a deeper panel like ApoB, fasting insulin, or a full thyroid set, we add what is missing rather than redoing everything.

Can I message Dr. Ash directly, or do messages go through staff?

You can message Dr. Ash directly through Ultralight. For administrative items like scheduling or referrals, our team handles it so clinical messages reach Dr. Ash quickly.

What if I am out of town during my first week?

You can complete every step of onboarding from anywhere. Records, wearable data, lab orders, and the Diagnostic Evaluation can all be handled remotely. You can complete labs at any LabCorp or Quest location nationwide.

How does the Diagnostic Evaluation differ from a typical physical?

A standard physical lasts about 15 minutes and centers on basic vitals and a checklist. Our Diagnostic Evaluation runs 90 minutes and reviews advanced biomarkers (ApoB, fasting insulin, hs-CRP, full thyroid panel), wearable data trends, family history, sleep patterns, and your specific goals. We leave with a written plan, not a coupon for a follow-up.

Why do you ask for wearable data before the first visit?

Wearable data shows what your body actually does between visits. Resting heart rate, heart rate variability, deep sleep, and total sleep tell a story that a single in-office reading cannot. Reviewing trends ahead of time means we can use the visit to discuss patterns instead of just collecting numbers.

What happens if my old PCP is slow to release records?

If your previous practice delays release, we have a few options. We can submit a follow-up request, escalate through the medical records office, or reconstruct key history from your memory and any documents you have. We do not let slow paperwork delay your care plan.

How do you handle prescriptions during onboarding?

We can refill stable medications during onboarding once we have confirmed your history. For controlled substances, we follow our [Controlled Substances Policy](/about/controlled-substances-policy), which usually requires a face-to-face visit before any refill.

Will my insurance be involved during onboarding?

Your insurance is not required for membership itself, since we are a Direct Primary Care practice. We can still order labs, imaging, and specialist referrals through your insurance when that saves you money. We explain the [insurance and benefits picture](/about/insurance-and-benefits-guide) during your first call.

How is my data protected during onboarding?

We use HIPAA-compliant platforms for messaging, video, and document sharing. The Ultralight app encrypts data in transit and at rest. Wearable data uploads happen through encrypted channels, and we never share data with third parties for marketing.

What if I have a complex chronic condition?

If you live with a chronic condition like diabetes, hypertension, autoimmune disease, or a complex GI issue, we adjust onboarding to fit. We may schedule your Diagnostic Evaluation sooner, request more detailed records, or coordinate with your existing specialists at Penn, Jefferson, or Mainline early in week one.

Can I bring my own labs or testing data?

Yes, you can bring your own labs. If you already have recent results from another physician, an executive physical, or a service like Function Health, upload them through Ultralight. Dr. Ash reviews them as part of your baseline.

How does onboarding work for new parents or busy professionals?

We designed onboarding to fit a chaotic schedule. Every step (record transfer, wearable upload, lab order, Diagnostic Evaluation) can happen asynchronously or by video. Most members complete the entire process around their work and family commitments without taking a day off.

What does the practice expect from me during the first week?

We ask three things. Download the app and confirm the message channel works. Sign the record release so we can pull your history. Show up to the Diagnostic Evaluation having reviewed any prep materials. Everything else, we handle.

How do you decide what to test in the first lab order?

The first lab order is tailored to your history and goals. Standard panels include a comprehensive metabolic panel, full thyroid (TSH, free T4, free T3), advanced lipids (ApoB, Lp(a)), fasting insulin, hs-CRP, hemoglobin A1c, vitamin D, and a complete blood count. We may add markers like ferritin, sex hormones, or specialty panels based on your individual story.

What if I need to see a specialist during onboarding?

If you need a specialist before week one ends, we coordinate it. Dr. Ash can often handle the question himself through a "specialist curbside" with our regional partners. If a procedure or in-person visit is needed, we schedule it through Penn, Jefferson, Temple, or Mainline depending on the case.

How does onboarding feel different from a typical Philly health system?

Most Philly systems route you through a phone tree, a portal, and a 6-week wait. Our onboarding gives you the same physician for every question, replies in hours rather than days, and ends with a real plan instead of a referral list. The pace is set by your needs, not by the system's queue.

TL;DR · 30-second take

Getting started with Fishtown Medicine takes about a week. Day 1, you set up the Ultralight app. Days 2 and 3, we transfer your records and wearable data. Days 4 through 7, you complete labs and book your 90-minute Diagnostic Evaluation with Dr. Ash.

The First Seven Days: Getting Started with Fishtown Medicine

TL;DR: Onboarding at Fishtown Medicine is designed to feel simple. Within your first week, we move your medical history into our secure system, link your wearable data, and schedule your initial Diagnostic Evaluation with Dr. Ash.

What happens on day one?
How do we move your records and wearable data?
When do you meet Dr. Ash?
Guidelines from the Clinic
Actionable Steps for Your First Week
Common Questions
Deep Questions

What happens on day one?

Day one is the digital welcome. The moment you join, you receive two emails that set up your direct line to the practice.

Welcome Email: Contains your unique link to download the Ultralight app. This app is your hub for all clinical communication, file sharing, and video visits.
Onboarding Packet: A digital document outlining our Practice Constraints and how to reach us for urgent versus routine needs.

Your first action

Download the Ultralight app and send a quick "Hello" message. This verifies that your secure, encrypted channel is active and ready for use.

How do we move your records and wearable data?

We move fast to get your history under one roof so you stop searching through old patient portals from different Philadelphia health systems.

Record Transfer: Use our Medical Record Release Guide to authorize the transfer of your history from Penn, Jefferson, Temple, or your previous PCP.
Wearable Data: If you use an Apple Watch, Oura, or Whoop, you can upload your data directly to our portal or email it to wearables@fishtownmedicine.com. This lets Dr. Ash see your baseline sleep, heart rate variability, and recovery data before your first visit.

The goal here is simple. Your first conversation with Dr. Ash should be about you, not about chasing down paperwork.

When do you meet Dr. Ash?

Most members meet Dr. Ash between days four and seven, after your records and labs are in the system.

The Prep: We may send a lab order through the Ultralight app so you can get your blood work done before your first consult. This way, the 90 minutes you spend together focus on interpretation and planning, not just ordering tests.
The Schedule: You receive a link to Dr. Ash's private calendar to choose a time that works for your week.

Guidelines from the Clinic

"The magic of relationship-based medicine happens when the logistics fade into the background. My goal is to make the technology so easy that by day seven, you feel completely connected to your care team. You aren't just another chart number; you are a partner in a multi-decade project to optimize your health."

Actionable Steps for Your First Week

A simple, low-stress checklist for new members.

Day 1: Download the Ultralight app and send a "Hello" message to confirm your channel is live.
Day 2 to 3: Sign your record release form and email any wearable data exports to wearables@fishtownmedicine.com.
Day 4: Complete the lab order if Dr. Ash sent one. Most Philly LabCorp and Quest sites are open by 7 a.m.
Day 5 to 7: Book your 90-minute Diagnostic Evaluation through the calendar link.
Anytime: Add a spouse or family member to your membership at the partner rate.

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.

Medical Disclaimer: This resource provides clinical context for educational purposes. In the world of Precision Medicine, there is no "one size fits all", the right onboarding plan must be matched to your unique history, physiology, and goals. Consult Dr. Ash to determine if this approach is right for you, especially if you have chronic health conditions or are taking prescription medications.

Dr. Ash is a board-certified internal medicine physician specializing in preventive medicine and healthspan optimization at Fishtown Medicine in Philadelphia.

Fishtown Medicine | About

2418 E York St, Philadelphia, PA 19125(267) 360-7927 hello@fishtownmedicine.comHSA/FSA Eligible

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Common Questions

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TL;DR · 30-second take

The First Seven Days: Getting Started with Fishtown Medicine

What happens on day one?
How do we move your records and wearable data?
When do you meet Dr. Ash?
Guidelines from the Clinic
Actionable Steps for Your First Week
Common Questions
Deep Questions