This patient membership agreement (the “Agreement”) specifies the terms and conditions under which you, the undersigned patient (“Patient”), may participate in the program (“Program”) offered by Elevated Healthcare, LLC. This Agreement will become effective either on the date your physician commences the Program or the date of your signature on this Agreement, whichever is later (the “Effective Date”).
The Program’s annual fee encompasses the following services (“Services”):
- 24/7 access to your doctor via telemedicine, text and phone
Same day or next day appointment availability
Online Personal Health Record
MONTHLY PATIENT FEE
You will pay an monthly fee of depending on your age and number of enrolled family members to Elevated Healthcare, LLC (“Monthly Fee”) for each year that you elect to participate in the Program.
RENEWALS AND TERMINATION
The Monthly Fee covers a period of one (1) month (the “Term)”. Failure to pay the renewal Annual Fee prior to the anniversary of the Effective Date shall result in termination of your participation in the Program. (For example, if the Effective Date is March 2, 2014, then you must renew on or before April 1, 2014.) You or your Physician may terminate this Agreement at any time upon 30-days written notice. If you or your Physician terminates this Agreement for any reason prior to receiving your services, you will be entitled to a prorated refund of the Monthly Fee. Upon Elevated Healthcare, LLC's. receipt of this Agreement and the Monthly Fee, your Physician shall have the option, in its sole and absolute discretion, not to accept the Agreement and to return your payment to you (e.g., due to limitation on the number of patients). Unless otherwise terminated, this Agreement shall automatically renew for an additional one-month period upon the expiration of each Term.
MEDICAL CARE SERVICES EXCLUDED FROM ANNUAL FEE
The Monthly Fee specified herein covers only the defined “Services” described in the Program section above. Except for your Services, you and/or your insurer, as the case may be, will be financially responsible for paying for all healthcare and medical care services received by you from your Physician and his or her staff. Elevated Healthcare. will bill you, as the case may be, for those healthcare or medical services provided to you. The limited practice size also enables your Physician to provide conveniences, such as same-day or next-day appointments that start on time, thorough visits, and 24/7 availability via secure app.
The undersigned agrees to the terms of this Agreement, all of which are expressed herein. There are no promises or representations except as set forth herein.
Any communication required or permitted to be sent under this Agreement shall be in writing and sent via U.S. mail to the addresses set forth in this Agreement. Any change in address shall be communicated in accordance with the provisions of this section.
Initial payments are processed at the time of enrollment. Subsequent payments are charged monthly or annually as elected by the Patient.