Membership Agreement

Introduction: This agreement outlines the terms and conditions of membership at True Potential Healthcare. By enrolling, members agree to these stipulations for the duration of their membership.

Membership Fees

1. Annual Membership Fee: A primary fee covering a broad range of concierge services. This fee is payable upfront or in an agreed-upon installment plan.
2. Monthly Fee Structure: An ongoing monthly fee to maintain and access the continuous concierge care services.
3. Payment Terms: Clear definitions of payment schedules, methods, and any late payment penalties.
4. Renewal and Cancellation: Automatic renewal terms, notice periods for cancellation by either party, and prorated refund policies.

Concierge Services Included

1. 24/7 Direct Access: Unrestricted access to Dr. Slendebroek or designated medical staff.
2. Extended Appointments: Longer, more thorough appointments.
3. Personalized Care Plans: Tailored health strategies and wellness planning.
4. Preventive and Wellness Services: Regular screenings, health monitoring, and wellness advice.
5. Coordination of Specialist Care: Referrals and coordination with a network of top specialists.
6. Health Records Management: Comprehensive and confidential handling of medical records.

Additional Charges

1. Specialized Services: Detailed list of services that incur additional charges and the circumstances under which these charges apply.
2. Notification and Consent: Procedure for informing patients about additional charges and obtaining consent prior to service delivery.
3. Billing and Payment for Additional Services: Clear and detailed billing practices for any additional services provided.

Communication and Privacy

1. Preferred Communication Method: Options for contacting the practice and preferences for communication, including virtual consultations.
2. Privacy Policy: Assurance of confidentiality and compliance with HIPAA and other relevant privacy laws.

Rights and Responsibilities

1. Member Rights: Including the right to receive information about services, costs, treatment options, and to refuse treatment.
2. Member Responsibilities: Including providing accurate health information, following agreed-upon treatment plans, and timely payment of fees.
3. Practice Rights and Responsibilities: Including the right to change terms, fees, or services with appropriate notice.

Dispute Resolution

1. Contact Information: Clear instructions on whom to contact with questions or concerns.
2. Grievance Process: Steps to resolve disputes or dissatisfaction with services provided.

Miscellaneous Provisions

1. Amendments to the Agreement: The process by which True Potential Healthcare may modify the terms or services.
2. Severability: If any part of the agreement is deemed unenforceable, the remainder will continue in effect.
3. Jurisdiction: Legal jurisdiction and venue for any disputes.
4. Entire Agreement: Statement that the membership agreement constitutes the entire agreement between the patient and True Potential Healthcare.

Signatures

1. Member Acknowledgement: Signature of the member acknowledging understanding and agreement to the terms.
2. Practice Acknowledgement: Signature of an authorized representative of True Potential Healthcare.