This MEMBERSHIP AGREEMENT (“Agreement”) is entered into between Client (“participant”) and STAT Wellness LLC as of the Commencement Date. In this Agreement, the terms “they”, “their”, and “them” refer to the participant.
By becoming a member of STAT Wellness LLC, the participant agrees to pay the price of the package every month for 12 months. This payment will be automatically drafted once a month on the same day each month. This day will coincide with the day of the month in which the participant initiated their membership.
Participant acknowledges that STAT Wellness LLC has the right to run specials and discounts on these services and that they are not obligated to guarantee these promotional prices to the participant once opted into the membership rate.
Participant acknowledges that no part of the membership fees will be paid for by their insurer, health plan, or any government programs including Medicare. All or a portion of the participant membership fee may be paid for by a third party such as an employer. The participant agrees to pay for any and all portions that are not paid by such third parties.
Upon payment of the membership fee, STAT Wellness LLC will make available to the participant the services agreed upon in the membership. The participant will have the ability to schedule and use these services at their discretion throughout the year. The participant acknowledges that any services not used within the 12 month period, beginning the day they make their first payment, will be lost and cannot be rolled over if they choose to purchase another membership the following year.
Services not specified as being included in the membership will not be included in the fee. The participant agrees to take full financial responsibility for any additional services they may require or desire. If they have insurance, they acknowledge that their provider may or may not cover the cost of any additional services.
Additional services may include but are not limited to:
- Laboratory tests performed by STAT Wellness LLC or another facility
- Supplements purchased through STAT Wellness LLC or another facility, such as FullScript.
- Axillary services recommended by STAT Wellness LLC that are not included in the membership include physical therapy, personal training, health coaching, registered dietician consults, injections, and intravenous therapy.
- Prescriptions and over the counter medication
- Extra functional medicine visits beyond the four included in this membership
STAT Wellness LLC will be authorized to charge my credit card monthly for my membership fees and for any services agreed upon at any time that is not included in my membership. The participant acknowledges and agrees that STAT Wellness LLC will not submit a medical claim to my insurance on my behalf and that STAT Wellness LLC cannot assist me with any claim resolutions.
Memberships are non-refundable and non-cancelable. Once checkout or renewal is complete, you may not terminate the contract without STAT Wellness LLC approval and that approval may or may not be granted. If approval is granted there may be associated cancellation fees required.
STAT Wellness LLC may terminate your Membership, at any time, upon breach of this agreement, non-payment of fees, harassment or threatening behavior, or any other action that places STAT Wellness LLC at risk of harm.
Participant understands this annual membership includes one 60 minute initial consult and three 30 minutes follow up visits per year. Each additional visit is discounted at $100. Participant understands that medical visits canceled within 24 hours are subject to a $50 late fee.
By agreeing to these terms, the participant is authorizing medical and health care treatment for themselves or their minor child by STAT Wellness LLC. Participant understands that as a patient of STAT Wellness LLC, they will receive care that will be determined following an initial assessment and thorough discussion with their healthcare provider. The goal of the assessment process is to determine the best course of treatment. Typically, treatment is provided on the day of service and over the course of several weeks, months, or years for chronic conditions.
The participant’s questions, concerns and possible or potential side effects of natural and conventional treatments will be discussed and disclosed to them. Everyone is different and responds differently to treatments therefore not all reactions are documented and can be predicted. It is the participant’s responsibility to keep STAT Wellness LLC informed of any medication or physical changes and diagnosis, so STAT Wellness LLC can coordinate it with the participant’s care and prevent any interactions with their treatment plan.
The participant understands that if any explanations as to benefits and/or risks and dangers of the prescribed treatments or services are unclear, it is their responsibility to ask for clarification before giving consent. The participant understands that there are no warranties, representations or assurances of successful outcomes for them. Nevertheless, the participant desires to pursue Functional Medicine for themselves after reviewing the information herein and receiving answers to any questions related to this agreement.
As a patient seeking medical, health care and/or nutrition services, the participant understands that they are ultimately responsible for selecting and approving recommended treatments and services (or rejecting recommended treatments/services).
The participant will report to STAT Wellness LLC any matters arising out of treatments or services and schedule a consultation to conduct appropriate follow-up. The participant will promptly seek medical attention from STAT Wellness LLC or another medical facility if they experience any unanticipated effects associated with treatments and services or if the treated condition worsens. If a medical emergency arises, the participant will call 911 or visit the nearest hospital emergency room.
The participant understands that STAT Wellness LLC provides Functional Medicine consults and does not function as an urgent care or concierge practice. STAT Wellness LLC does not have on-call duties. The participant is expected to have a relationship with a primary care provider separate from STAT Wellness LLC.
TeleHealth visits are available upon request. The participant understands that TeleHealth is the use of electronic information and communication technologies by a health care provider to deliver services to an individual when he/she is located at a different site than the provider, and hereby consent to STAT Wellness LLC providing health care services to the participant via TeleHealth as appropriate. The participant understands these visits count as Functional Medicine visits included in their membership plan.
The participant authorizes STAT Wellness LLC to communicate with them by Electronic Communication regarding their personal health information, as defined in the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations) via my cell phone and/or e-mail provided at checkout or in connection with your account. Electronic Communication includes but is not limited to email, text (SMS, MMS, Instant Messaging), and video conference. The participant understands this may not be a secure form of communication.
The participant understands their membership includes unlimited group, fitness classes. It is their responsibility to reserve a spot through MINDBODY prior to attending. The participant understands class sizes are limited and they are not guaranteed a spot.
The participant understands that classes canceled within 12 hours are subject to a late cancellation fee of $25.
Due to the risks associated with strenuous exercise, the participant understands it is their responsibility to have a physical examination prior to participating to deem they are fit enough to exercise.
MONTHLY EDUCATIONAL EVENTS
The participant understands their membership includes monthly educational events on the first Wednesday of every month. It is their responsibility to sign up for these events ahead of time through the MINDBODY software, due to limited space.
The participant understands this membership includes 10% off all in house retail or supplements ordered through FullScript.
Any questions or concerns I have regarding this agreement will be addressed with STAT Wellness LLC.