Terms of Service & Consent to Treat

Motion Clinical, Inc., and its subsidiaries and affiliated companies (collectively, “Motion” “we”, “us” and “our”), thank you for using these Services. The Services offer our users the ability to manage their health care online.  These terms of service (“Terms of Service”) govern your access to and use of the Services, websites (“Sites”), mobile applications (“Apps”) and other online services, in each case that we own and/or operate and that link to these Terms (collectively, the “Services”).  The Services include all software and content provided through or as part of the Services.  Please carefully review these Terms, our Privacy Policy, the HIPAA Policy, the Website Terms of Use, and any other notices on the Website.  These policies collectively (the “Terms”) govern your use of the Services.    

By clicking Agree, you acknowledge that you have read, accepted, and agreed to be bound by these Terms. We may change the Terms from time to time, at any time without notice to you, by posting such changes on the Sites or Apps.  BY USING THE SERVICES, YOU ACCEPT AND AGREE TO THESE TERMS.  If you do not agree to these Terms, you should not access or otherwise use the Services.

 

IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911.

THE SERVICES MIGHT NOT BE APPROPRIATE FOR ALL MEDICAL CONDITIONS OR CONCERNS.

The Services may provide the infrastructure to allow you to contact physicians who may participate as part of the Services.  DO NOT USE THE SERVICES FOR EMERGENCY MEDICAL NEEDS.  IF YOU THINK YOU ARE HAVING A MEDICAL EMERGENCY, CALL 911 FOR EMERGENCY MEDICAL SERVICES.

In providing the Services, we do not provide medical care services

We provide technologies to help health care providers manage their medical practices.  We also operate a portal wherein health care providers and patients may manage their accounts and records.

We provide a platform that delivers telehealth services.  "Telehealth" is the delivery of healthcare services using technology when the healthcare provider and patient are not in the same physical location, and/or the virtual delivery of healthcare services, including by a medical provider or via digital or automated tools, including without limitation tools for medical or health-related diagnosis and treatment. Telehealth may be used for diagnosis, treatment, follow-up and/or patient education, and may include, without limitation, the following: electronic transmission of patient medical records, medical images, or other patient data; synchronous (i.e., "real time") and asynchronous (i.e., non-"real time") interactions via audio, video, and/or data communications; automated or digital tools for diagnosis, care, treatment and/or communication pertaining to healthcare or medical matters; and output data from medical devices, sound and video files. Further, you understand that it may be possible that your condition cannot be treated via Telehealth, or that information transmitted through Telehealth may not be sufficient or of too poor of image quality, or insufficient information or data to allow for appropriate medical decision making. Accordingly, you may be required to seek additional in-person medical care, alternative healthcare or emergency services. You agree that if your health or medical problem or condition persists after use of Telehealth via the Services, you will immediately contact your medical services provider and seek appropriate additional in-person medical care or emergency care, as appropriate. You understand that while using the Services offers potential benefits, there are potential risks.  You acknowledge these risks and consent to the use of automated tools for diagnosis, treatment, care, or other communication pertaining to healthcare matters. 

WE DO NOT WARRANT THE VALIDITY, ACCURACY, COMPLETENESS, SAFETY, LEGALITY, QUALITY, OR APPLICABILITY OF THE SERVICES (INCLUDING WITHOUT LIMITATION THE THIRD PARTY ELEMENTS) OR ANYTHING SAID OR WRITTEN BY ANY PHYSICIAN.  WE WILL NOT BE LIABLE FOR ANY DAMAGES SUSTAINED DUE TO YOUR RELIANCE ON SUCH INFORMATION. We make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or affect on any person following the general information offered or provided by the Service. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.

Services-Specific Terms. These Terms contain general terms that apply to all our Services, as well as certain terms that apply only to a particular Service (“Services-Specific Terms”).  We also may present to you or post additional Services-Specific Terms through the Services that apply to particular features of the Services.  To the extent that these Terms conflict with the Services-Specific Terms, the Services-Specific terms will control.

 

ACCEPTANCE OF TERMS

These Terms constitute an electronic contract that explains the legally binding terms of your use of the Services.  By using the Services, you accept and agree to these Terms and any conditions or notices contained or referenced within.  You acknowledge that these Terms may be modified by us at any time, in our sole discretion, and that any modifications will be effective upon posting a notice on the Website or via the Services. Your continued use of the Services shall indicate your acceptance of any modified terms.

By using the Services, you also agree that we may send you various communications by email or posting them on the Website.  You agree to notify us promptly if your email address changes.  This consent covers all actions you conduct through the Service. Should you decide that you do not wish to receive communications by email, please contact us at [email protected].  Your withdrawal of consent will be effective within a reasonable time after we receive such notice.  A withdrawal of consent will not affect the enforceability of these Terms.  However, a withdrawal of consent to receive communications electronically may result in termination of your use of the Services.

 

USER ACCOUNT AND ELIGIBILITY

In order to access certain features of the Services, you must create a User Account.  Our Services are designed and intended for those located in California and who are at least 18 years of age.  By using our Services, you represent and warrant that you are (a) at least 18 years of age or older; (2) at least 13 years of age and your parent or legal guardian has provided us with valid and verifiable consent to use the Services; or (c) the parent or legal guardian of a minor child and are using the Services on behalf of such minor child with full capacity and legal authority to do so.  If you are between the ages of 13 and 18, you may still use the Service, but you must have a parent or legal guardian provide valid and verifiable consent to your use of the Services and accept these Terms and acknowledge our Privacy Policy, in each case as required by the Services or as otherwise required by Motion. If we determine at any time that the consent provided is invalid or inadequate, we may suspend or terminate your access to or use of the Services. If you are under the age of 13, the Services may still be utilized by your parent or legal guardian on your behalf, but you may not use the Services directly. If we determine at any time that a child under the age of 13 has created an account through the Services (as opposed to being created by the child’s parent or legal guardian), we will terminate such child’s user account and remove all information regarding such child from our systems. Our Services are subject to state regulations and may change from time to time due to changes in applicable regulatory requirements.  You may use the Services only with our permission and we reserve the right to revoke the permission at any time, for any reason, in our sole discretion.

It is your responsibility to provide us with accurate, complete, and up-to-date information for your account.  You agree to update such information as needed.  You are responsible for maintaining the confidentiality of your user name and password and are fully responsible for all activities that occur on your account or any other breach of security.  You agree to (a) notify us immediately if you suspect any unauthorized access on your account and (b) log-off each time following your use of your account.  We are not liable for any loss or damage arising from your failure to comply with this provision.  Use caution when accessing your account from a shared or public computer.

California law allows California residents to ask companies with whom they have an established business relationship to provide certain information about the companies’ sharing of personal information with third parties for direct marketing purposes.  We do not share any California consumer personal information with third parties for marketing purposes without consent.  California customers who wish to request further information about our compliance with this law or have questions or concerns about our privacy practices may contact us using the contact information set forth below.

 

TERM AND TERMINATION

These Terms remain in full force and effect while you are a User.  You may terminate your use of the Services at any time by contacting us at [email protected].  Please allow a reasonable amount of time for your subscription to be fully terminated.  Your subscription will terminate at the end of the subscription period. 

We may, in our sole discretion, terminate your use of the Services at any time, including, but not limited to, if you breach these Terms, by sending a notice to you at the email address associated with your User Account.  We are not required to provide you with prior notice or a reason for the termination.  You will not be entitled to any refund.  After termination, these Terms will remain in full force and effect.  We will maintain all information to comply with applicable law. 

 

PROPRIETARY RIGHTS AND TRADEMARKS

As between you and us, we own or have licensed from third parties (including the providers of Content, see below), the right, title and interest in and to the Services, the content (including, for example, audio, photographs, illustrations, graphics, other visuals, video, copy, text, software, titles, etc.), code, data and materials used in connection with the Services, the look and feel, design and organization of the Services, and the compilation of the content, code, data and materials on the Services, including but not limited to any copyrights, trademark rights, patent rights, database rights, moral rights and other intellectual property and proprietary rights therein. Your use of the Services does not grant to you ownership of any content, code, data or materials you may access on or through the Services, or download from the Services.

The trademarks, logos, service marks and trade names (collectively the “Trademarks”) displayed or used on the Services or on material available through the Services are our registered and unregistered Trademarks and may not be used in connection with products and/or services that are not related to, associated with, or sponsored by their rights holders that are likely to cause customer confusion, or in any manner that disparages or discredits their rights holders. All Trademarks not owned by us that appear on the Services, if any, are the property of their respective owners. Nothing contained on the Services should be construed as granting, by implication or otherwise, any license or right to use any Trademark displayed on the Services without our written permission or the third party that may own the applicable Trademark. Your misuse of the Trademarks displayed on the Services is strictly prohibited.

 

USER CONTENT

In our sole discretion, we may periodically allow Users to publicly post, upload, publish, or otherwise submit content through the Services (“User Content”).  By submitting any User Content, you grant us a non-exclusive, transferable, sub-licensable, worldwide, royalty-free license to use, copy, disclose, distribute, incorporate, modify, publicly display, and create derivative works based on your User Content and all data, images, sounds, text, and other things embodied therein only in connection with operating and providing the Services to you. 

You warrant to us that you own all submitted User Content or that you have the necessary rights to grant us the license rights in your User Content under these Terms.  You further represent that your User Content does not infringe or otherwise violate a third party’s rights or result in the violation of any applicable law or regulation. You will not provide inaccurate, misleading, or false information via the Services.

It is important to remember that the Content you submit and upload may be stored in multiple places, both on our Services and elsewhere on the Internet, which are likely to be accessible for a long time and you have no control over who will view it over time. It is therefore important that you are careful about the personal information that you disclose about yourself and others. Please do not submit private or sensitive information. If you do so inadvertently, your information will be used and disclosed in the same manner as any other information you provide to us in accordance with our Privacy Policy.

You understand and agree that we maintain the right to review and delete or modify any User Content for any reason.  We also reserve the right to investigate any violations of these Terms or conduct that affects the Services.  We may also consult or cooperate with law enforcement authorities to prosecute Users who violate the law.

We will not claim any ownership rights in any User Content. 

You may remove your User Content by specifically deleting it.  However, some of your User Content may not be completely deleted and copies may exist in the Services.  We are not liable for the removal or deletion, or the failure to remove or delete, any of the User Content.

You may not engage in any advertising to or solicitation of other Users. You may not harass, abuse, or harm another User.  Your use of the Services must be in accordance with all applicable laws and regulations.

 

PROHIBITED USES

Any commercial or promotional use, distribution, reproduction or other exploitation of the Services, or any content, code, data or materials on the Services, is strictly prohibited unless you have received the express prior written permission from us. Other than as expressly allowed in these Terms of Use, you may not download, post, display, publish, copy, reproduce, distribute, transmit, modify, perform, broadcast, transfer, create derivative works from, sell or otherwise exploit any content, code, data or materials on or available through the Services. You further agree that you may not alter, edit, delete, remove, otherwise change the meaning or appearance of, or repurpose, any of the content, code, data, or other materials on or available through the Services, including, without limitation, the alteration or removal of any trademarks, trade names, logos, service marks, or any other proprietary content or proprietary rights notices. If you make other use of the Services, or the Services’ content, code, data or materials, except as otherwise provided above, you may violate copyright and other laws of the United States, other countries, as well as applicable state laws and may be subject to liability for such unauthorized use.

You shall not: (i) engage in spidering, “screen scraping,” “database scraping,” harvesting of e-mail or other addresses, contact or personal information, or any other automatic means of obtaining lists of users or other information from or through the Services, including without limitation any information residing on any server or database connected to the Services; (ii) obtain or attempt to obtain unauthorized access to computer systems, materials or information through any means; (iii) use the Services in any manner with the intent to interrupt, damage, disable, overburden, or impair the Services, including, without limitation, sending mass unsolicited messages or “flooding” servers with requests; (iv) use the Services in violation of our or any third party's intellectual property or other proprietary or legal rights; (v) insert your own or a third party’s advertising, branding or other promotional content into any of the Services’ content, materials or services, or (vi) use the Services in violation of any applicable law. You further agree that you shall not attempt (or encourage or support anyone else's attempt) to circumvent, reverse engineer, decrypt, or otherwise alter or interfere with the Services, or any content thereof, or make any unauthorized use thereof. You agree that you shall not use the Services in any manner that could damage, disable, overburden, or impair the Services or interfere with any other party's use and enjoyment of the Services.

 

MODIFICATIONS

We reserve the right to modify or discontinue, temporarily or permanently, the Services or any part thereof with or without notice.  You agree that we are not liable to you or any third party for any modification, suspension, or discontinuance of the Service.

 

COPYRIGHT POLICY

We respect the intellectual property rights of others, and require that the people who use the Website, or the features made available on or through the Website, do the same. If you believe that your work has been copied in a way that constitutes copyright infringement, please forward the following information to our Copyright Agent, designated as such pursuant to the Digital Millennium Copyright Act, 17 U.S.C. § 512(c)(2), named below:

  • Your address, telephone number, and email address;
  • A description of the copyrighted work that you claim has been infringed;
  • A description of where the alleged infringing material is located;
  • A statement by you that you have a good faith belief that the disputed use is not authorized by the copyright owner, its agent, or the law;
  • An electronic or physical signature of the person authorized to act on behalf of the owner of the copyright interest; and
  • A statement by you, made under penalty of perjury, that the above information in your notice is accurate and that you are the copyright owner or are authorized to act on the copyright owner's behalf.

Motion's Copyright Agent for notice of claims of copyright infringement can be reached as follows: Copyright Agent, Motion, 480 2nd St. Suite 100, San Francisco, CA 94107.

 

PRIVACY

For detailed information on how we collect, use, and disclose information from our Users, please carefully review our Privacy Policy and our HIPAA Policy.

 

DISCLAIMERS

THE SERVICES, INCLUDING, WITHOUT LIMITATION, ALL SERVICES, CONTENT, FUNCTIONS AND MATERIALS PROVIDED THROUGH THE SERVICES, ARE PROVIDED “AS IS,” “AS AVAILABLE,” WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY FOR INFORMATION, DATA, DATA PROCESSING, UPTIME OR UNINTERRUPTED ACCESS, ANY WARRANTIES CONCERNING THE AVAILABILITY, USABILITY, ACCURACY, PRECISION, CORRECTNESS, COMPLETENESS, OR USEFULNESS, AND ANY WARRANTIES OF TITLE, NON-INFRINGEMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, AND WE HEREBY DISCLAIM ANY AND ALL SUCH WARRANTIES, EXPRESS AND IMPLIED. WE DO NOT WARRANT THAT THE SERVICES OR THE, CONTENT, FUNCTIONS OR MATERIALS PROVIDED ON OR THROUGH THE SERVICES WILL BE TIMELY, SECURE, UNINTERRUPTED OR ERROR FREE, OR THAT DEFECTS WILL BE CORRECTED. NO ADVICE, RESULTS OR INFORMATION, WHETHER ORAL OR WRITTEN, OBTAINED BY YOU FROM US OR THROUGH THE SERVICES SHALL CREATE ANY WARRANTY NOT EXPRESSLY MADE HEREIN. WE ALSO ASSUME NO RESPONSIBILITY, AND SHALL NOT BE LIABLE FOR, ANY DAMAGES TO, OR VIRUSES THAT MAY INFECT, YOUR EQUIPMENT ON ACCOUNT OF YOUR ACCESS TO, USE OF, OR BROWSING IN THE SERVICES OR YOUR DOWNLOADING OF ANY MATERIALS, DATA, TEXT, IMAGES, VIDEO CONTENT, OR AUDIO CONTENT FROM THE SERVICES.

WE TRY TO ENSURE THAT THE INFORMATION POSTED ON THE SERVICES IS CORRECT AND UP-TO-DATE. WE RESERVE THE RIGHT TO CHANGE OR MAKE CORRECTIONS TO ANY OF THE INFORMATION PROVIDED ON THE SERVICES AT ANY TIME AND WITHOUT ANY PRIOR WARNING. WE NEITHER ENDORSE NOR ARE RESPONSIBLE FOR THE ACCURACY OR RELIABILITY OF ANY OPINION, ADVICE OR STATEMENT MADE IN THE CONTENT PROVIDED BY USERS.

 

THIRD PARTY WEBSITES

You may be able to link from the Services to third party websites and third party websites may link to the Services (“Linked Sites”). You acknowledge and agree that we have no responsibility for the information, content, products, services, advertising, code or other materials which may or may not be provided by or through Linked Sites. Links to Linked Sites do not constitute an endorsement or sponsorship by us of such websites or the information, content, products, services, code or other materials presented on or through such websites. The inclusion of any link to such sites on our Services does not imply our endorsement or recommendation of that site and we do not represent or warrant that the contents of any third party website is accurate, compliant with state or federal law, or compliant with copyright or other intellectual property laws. Any reliance on the contents of a third party website is done at your own risk.

 

LIMITATION OF LIABILITY

IN NO EVENT, INCLUDING BUT NOT LIMITED TO NEGLIGENCE, SHALL WE, ANY OF OUR DIRECTORS, ADVISORS, OFFICERS, EMPLOYEES, AGENTS OR CONTENT OR SERVICE PROVIDERS (COLLECTIVELY, THE “PROTECTED ENTITIES”) BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY OR PUNITIVE DAMAGES ARISING FROM, OR DIRECTLY OR INDIRECTLY RELATED TO, THE USE OF, OR THE INABILITY TO USE, THE SERVICES OR THE CONTENT, MATERIALS AND FUNCTIONS RELATED THERETO, YOUR PROVISION OF INFORMATION VIA THE SERVICES, EVEN IF SUCH PROTECTED ENTITY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. SOME JURISDICTIONS DO NOT ALLOW THE LIMITATION OR EXCLUSION OF LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES SO SOME OF THE ABOVE LIMITATIONS MAY NOT APPLY TO CERTAIN USERS. IN NO EVENT SHALL THE PROTECTED ENTITIES BE LIABLE FOR OR IN CONNECTION WITH ANY CONTENT POSTED, TRANSMITTED, EXCHANGED OR RECEIVED BY OR ON BEHALF OF ANY USER OR OTHER PERSON ON OR THROUGH THE SERVICES.

 

INDEMNIFICATION

You agree to defend, indemnify and hold us and our directors, advisors, officers, employees and agents harmless from any and all claims, liabilities, costs and expenses, including attorneys' fees, arising in any way from your use of the Services, your placement or transmission of any message, the Content, or other information or materials through the Services, or your breach or violation of the law or of these Terms of Services. We reserve the right, at our own expense, to assume the exclusive defense and control of any matter otherwise subject to indemnification by you, and in such case, you agree to cooperate with our defense of such claim.

 

NO ILLEGAL OR MALICIOUS USE

No User may use the Services for any illegal, malicious or unauthorized purpose or to abuse, harass, threaten, intimate, or impersonate any other User.  Any such use will result in termination to the User’s access to the Services and of the User’s account. 

 

NON-COMPLIANCE

If a User does not comply with any aspect of these Terms, we may (without prejudice to any other rights or remedies available to it) cancel or suspend that User’s account, disable the ability of that User to use the Services, and/or terminate these Terms.  We shall not be liable for any loss or damage suffered by Users as a result of our exercise of rights under this clause.

 

SECURITY 

We take reasonable measures to keep User Account Information secure against unauthorized use or access.  However, Users shall be responsible for maintaining the security of their account by keeping their User Account Information, Passcode number and log-in details confidential and secure, and not sharing any such information with any third party.  Users must select their Passcode numbers carefully, and Passcode numbers must not be sequential or easily-identifiable numbers (for example, birthdates, 1-2-3-4, or 1-1-1-1).

We shall not be liable for any loss, cost, or damage suffered as a result of any unauthorized use of the Services by any third party caused by a User’s failure to comply with these provisions.  Users must notify us immediately if they suspect or become aware of any unauthorized or fraudulent use of their account.

 

APPLICABLE LAWS

We control and operate the Website from the United States of America. We do not represent that materials on the Website are appropriate or available for use in other locations. Persons who choose to access the Website from other locations do so on their own initiative, and are responsible for compliance with local laws, if and to the extent local laws are applicable. All parties to these terms and conditions waive their respective rights to a trial by jury.

Our Website is subject to the United States export control laws and regulations, and may be subject to export or import regulations in other countries. You agree to strictly comply with all such laws and regulations and acknowledge that you have the responsibility to obtain authorization to export, re-export, or import any data on our Website, as may be required.

 

CHANGES TO TERMS OF SERVICE

We reserve the right, at our sole discretion, to change, modify, add or remove any portion of the Terms of Service, in whole or in part, at any time. Changes in the Terms of Service will be effective when posted. Your continued use of the Services after any changes to the Terms and Conditions are posted will be considered acceptance of those changes.

 

ASSIGNMENT

You may not assign or transfer these Terms of Service, by operation of law or otherwise, without our prior written consent and any attempt by you to do so shall be null and of no effect.  We may assign or transfer these Terms, at our sole discretion, in connection with the merger, acquisition, or sale of any or all of our business and/or our assets to a third party.  Subject to the foregoing, these Terms will bind and inure to the benefit of the parties, their successors and permitted assigns.

 

MISCELLANEOUS

The Terms, and the relationship between you and us, shall be governed by the laws of the State of California, United States of America.  You agree that any cause of action that may arise under the Terms of Use shall be commenced and be heard in the appropriate court in the County of San Francisco, State of California, United States of America.  You agree to submit to the personal and exclusive jurisdiction of the federal and state courts located within San Francisco County in the State of California.  Our failure to exercise or enforce any right or provision of the Terms shall not constitute a waiver of such right or provision.  If any provision of the Terms is found by a court of competent jurisdiction to be invalid, the parties nevertheless agree that the court should endeavor to give effect to the parties' intentions as reflected in the provision, and the other provisions of the Terms remain in full force and effect.

 

CONSENT FOR TREATMENT

This Consent for Treatment provides Motion Lord Chiropractic Corporation (collectively, “the Practice” “we”, “us” and “our”) with your permission to perform reasonable and necessary medical examinations, testing and treatment.  Please carefully review this Consent for Treatment and our HIPAA Policy.  By clicking Agree, you acknowledge that you are voluntarily seeking health care and hereby consent to receive treatment from the Practice. You acknowledge that you are at least 18 years of age, an emancipated minor, or the parent/legal guardian of a minor under 18 years of age.

Telehealth Medical Treatment

By clicking "Accept" during the account registration process, you give permission to the Practice’s health care providers to medically care for you in person, and, if applicable, by Telehealth, (defined above and incorporated by reference herein) as applicable and appropriate. You may withdraw this consent at any time by both terminating your account and no longer seeking care from the Practice.  Before consenting to treatment, please carefully review our Notice of Privacy Practices.

You understand that virtual encounters with the Practice or our Telehealth services via phone, email, an app or otherwise, could involve, and you hereby consent to the use of, automated tools for diagnosis, care, treatment or communication pertaining to healthcare matters. You also acknowledge that such virtual encounters with the Practice may be provided by a variety of healthcare providers, including chiropractors and physical therapists.

Complementary Services Disclaimer

You understand that methods of treatment for the Practice’s Complementary and Alternative Medicine ("CAM") services may include, but are not limited to: acupuncture, cupping, electrical stimulation, chiropractics, and nutritional counseling.

  • Chiropractic medicine is generally a safe method of treatment, but it may have side effects, including strokes, dislocations, and pains.
  • Nutrition consultation services are not licensed by most states in the U.S. The methods of evaluation employed, which may include diet, supplementation, and assessment analysis, are not intended to diagnose disease.
  • Acupuncture is generally considered a safe method of treatment, but it carries risks and may have side effects, including without limitation, bruising, numbness, or tingling near the needling sites that may last a few days, and dizziness or fainting. Bruising is a common side effect of cupping.
  • Unusual risks of acupuncture include spontaneous miscarriage, nerve damage and organ puncture, including lung puncture (pneumothorax). 

You acknowledge that you understand that while this section describes the major risks of treatment, other side effects and risks may occur.

You will immediately notify the provider who is caring for you if you are or become pregnant, as this may affect your treatment protocol. You will consult with a medical physician to be screened for any predispositions to injuries and risks in regard to any of the CAM treatments.

You will consult with a medical physician to address serious health concerns and to avoid any contraindications.

You understand that the Complementary and Alternative Medicine modalities are not a substitute for allopathic medical care and the CAM providers cannot anticipate all possible risks and complications of treatment. You will immediately notify your provider of any unanticipated or unpleasant effects associated with any of your CAM treatments.

You hereby give consent to any of the CAM providers at the Practice to assess and care for your present condition and any other future conditions for which you seek attention via the Services.

Payment

You authorize the Practice to bill your insurance plan on your behalf for any expenses incurred. You accept responsibility for payment for all services not covered by your insurance plan, including any visit fees. These charges may be paid on the day of service.

Duration

You intend this consent form to cover the entire course of treatment for your present condition(s) and for any condition(s) for which you seek treatment in the future.  This Consent for Treatment can be revoked by you at any time by written notification and is valid until revoked.

Electronic Correspondence

As part of the Services that we provide, you consent to receive emails, texts, or other communications from us pertaining to your care and your health (such as automated health reminders).  By utilizing our services or replying to our emails, you acknowledge that you are aware that email is not a secure method of communication, and that you agree to the risks. If you would prefer not to exchange personal health information via email, please notify us at [email protected].

Cancellation Policy

You agree that if you do not show up for your appointment or cancel your appointment with less than 24 hours’ notice, you may be charged a fee.

You have had the opportunity to have any questions answered to your satisfaction. You have fully evaluated the risks and benefits of treatment by the Practice. You have freely decided to undergo treatment, and hereby give your full consent to treatment.

 

Contacting Us

If you have any questions or comments about these Terms, please email us at [email protected].

Updated October 19th, 2017.

I HAVE READ THIS AGREEMENT AND AGREE TO ALL OF THE PROVISIONS CONTAINED ABOVE.