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SERVICE AGREEMENT- New Patient Session

Welcome! This agreement is designed to welcome you to Brandywine Center for Integrative Medicine, and to outline the terms of the Service.

This Service is based on the following premises:

• Dr. Ritz recognizes you to be powerful and fully capable of creating the results you desire to create
• Your relationship with Dr. Ritz will be built on the concept of a partnership, in which you both agree to be invested, engaged, and active participants
• Dr. Ritz recognizes that you are not broken and you don't need to be "fixed"; you simply require insight, support, and guidance around the changes and plan that will be most beneficial to you
• Dr. Ritz relies on your participation and engagement to produce the best results
• You are ultimately responsible for the results you choose to create through your participation in this Service

Due to the nature of Dr. Ritz's work, and because this Service constitutes a unique approach, you are required to be fully invested in the process in order to get the best results.  Additionally, there are several legal and business premises that are outlined below.   These are set in place to allow Dr. Ritz to offer this unique and powerful Service, which is often not considered "standard of care" medicine.  This is ultimately designed to be of benefit to you in achieving your desired results.

Please know that Dr. Ritz approaches her relationship with each and every patient as a true partnership, and takes her part in your health recovery very seriously. 

The intention of this Service is to bring you the best results as quickly as reasonably possible, and for those results to be lasting.

Introduction; Effective Date

This program agreement (“the Agreement”) between you, the undersigned practice participant (“Patient Client”) and Brandywine Center for Integrative Medicine, Inc., a Delaware Corporation (“Company”), specifies the terms and conditions under which you may participate in the Service (“Service”) offered by Company through Kendall Ritz, MD and Company’s other employees, staff, and agents (collectively, “Company Personnel”) at or through Company, as described below.

This agreement becomes effective on the date you, the Patient Client, register for the Service and sign this agreement.

Not Primary Care

You understand, acknowledge, and agree that neither Company nor any Company Personnel practice primary care and that none of these are responsible for providing you primary care services, but rather focus on enhancing your wellness through Functional Medicine, coaching, and other methods.  You understand, acknowledge, and agree that this approach may not be considered “standard of care” medicine and you agree to knowingly and willingly participate in said Service.

Service

The Service encompasses the services described below (also see section- Service Details) (collectively, the  "Service”):

Dr. Ritz will exercise her professional judgment as to which tests to order and when, what reports to generate, what recommendations and suggestions to make, and so on; Patient Client acknowledges and understands that medicine and wellness are an art and require considerable professional judgment and discretion, and vary from individual to individual, and that Functional Medicine may or may not be considered standard of care, but has received acceptance from a respectable group of physicians within the medical community.

The following services are not included as part of the Service:

1. Any fees for recommended lab work
2. Any fees for recommended dietary supplements
3. Any fees for recommended or prescribed medications
4. Any fees for consultation with a nutritionist or other allied health or complementary care professional to whom Company or Company Personnel refers you, even if such provider rents space from and works in the same office or office building as Company or Company Personnel.

The additional charges for these excluded services and products vary widely, depending on your particular needs and insurance coverage.

For emergencies, please dial 911.

The following office policies apply regarding rescheduling appointments:  Appointments must be rescheduled with a minimum of twenty-four (24) hours’ telephone or email notice; otherwise an appointment is forfeited and a new appointment will be used from the remaining appointments when rescheduling, if applicable.

The Services are intended to be services that are not covered by any private health insurance policy, private health plan or government program, including, but not limited to, Medicare/Medicaid, in which you may be enrolled (individually and collectively, the “Health Insurance Plans”). 

You understand and acknowledge that the provision of Services under this Agreement constitutes the establishment of a direct relationship between you and Company, and is therefore not subject to any guidelines, restrictions or contracts established by health insurance companies, health maintenance organizations, hospital service organizations, or Medicare/Medicaid programs.  Accordingly, you acknowledge that no reimbursement will be provided under any of the same for the Services.

Telemedicine

“Telemedicine” involves the delivery of clinical health care services by two-way audio-visual electronic communication, as defined by applicable law. Use of telemedicine services by Dr. Ritz can result in benefits such as improved access to care; potential risks include gaps of failures in communication, complicating healthcare decision-making, notwithstanding reasonable efforts to ensure the quality and reliability of transmitted information. You understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine.  You understand and agree to participate in telemedicine services.

Compensation

You agree to compensate Company either in full or according to the following payment schedule set forth in the Service Details section below.

Refunds

Upon execution of this Agreement, Patient Client will have 3 business days to rescind this agreement.  After 3 days, Patient Client shall be responsible for the full extent of the Fee (as defined below).  If Patient Client cancels participation after the 3 days for any reason whatsoever, Patient Client will receive no refund.

Payment Security

To the extent that the Patient Client provides Company with Credit-Card(s) information for payment on Patient Client’s account, Company shall be authorized to charge Patient Client’s Credit Card(s) for any unpaid charges on the dates set forth in Program Details section.  If Patient Client uses a multiple-payment plan to make payments to Company, Company shall be authorized to make all charges at the time they are due and not require separate authorization in order to do so.  Patient Client shall not make any chargebacks to Company’s account or cancel the credit card that is provided as security without Company’s prior written consent.  Patient Client is responsible for any fees associated with recouping payment on chargebacks and any collection fees associated therewith.  Patient Client shall not change any of the credit card information provided to Company without notifying Company in advance.

Not Insurance

Patient Client understands that this Agreement is not an insurance plan, not a contract for health insurance, and not a substitute for health insurance or other health plan coverage.  In the event of an emergency, Patient Client will call 911 or the nearest emergency room, and follow the directions of emergency personnel.

Termination

In the event that Patient Client is in arrears of payment or otherwise in default of this Agreement, all payments due hereunder shall be immediately due and payable.  Company shall be allowed to immediately collect all sums from Patient Client and terminate providing further services to Patient Client.  In the event that Patient Client is in arrears of payments of Company, Patient Client shall be barred from using any of Company’s services.

Intellectual Property

Company’s copyrighted and original materials shall be provided to Patient Client for individual use only and a single-user license.  Patient Client is not authorized to use any of Company’s intellectual property for your business purposes.  Patient Client is not authorized to share, copy, distribute, or otherwise disseminate any materials received from Company electronically or otherwise without the prior written consent of the Company.  All intellectual property, including Company’s copyrighted course materials, shall remain the sole property of the Company.  No license to sell or distribute Company’s materials is granted or implied.

No assignment

This Agreement is not transferrable or assignable without the Company’s prior written consent.

Limitation of Liability

By using Company’s services and enrolling in the Service, Patient Client releases Company, its officers, employees, and related entities from any and all damages that may result from anything and everything.  Patient Client accepts any and all risks, foreseeable and unforeseeable, arising from participation in the Service.  Company and Company Personnel each have no liability to Patient Client for any incidental and consequential damages, whether or not foreseeable or contemplated by Company or Company Personnel (including but not limited to any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to Patient Client, whether from technical failures or otherwise).  Notwithstanding the foregoing, in the event Company or any Company Personnel is found to be liable, such liability hereunder shall be limited to the lesser of the aggregate fees paid to Company by Patient Client for the Service, and $750.  All claims against Company or Company Personnel must be lodged with the entity having jurisdiction within 100-days of the date of the first claim or otherwise be forfeited forever.  Patient Client agrees that Company and/or Company Personnel will not be held liable for any damages of any kind resulting or arising from including but not limited to: direct, indirect, incidental, special, negligent, consequential, or exemplary damages happening from the use or misuse of Company’s services or your enrollment in the Service.  Patient Client agrees that use of Company’s services is at Patient Client’s own risk.

Disclaimer of Guarantee

Patient Client accepts and agrees that she/he is 100% responsible for progress and results from the Service.  Company and Company Personnel make no representations or guarantees verbally or in writing regarding performance of this Agreement other than those specifically enumerated herein.    Although Company aims to enhance overall health and wellness which can lead to good outcomes, neither Company nor Company Personnel makes any guarantee or warranty that the Service will meet your requirements or that all participants will achieve the same results, or any particular result (including, for example, a successful pregnancy and healthy baby, or, cure of a particular disease).

Clear Understanding

Patient Client acknowledges that the terms of this Agreement are clear and that no undue pressure has been exerted on Patient Client to sign this Agreement.

Communications

Notwithstanding the Notices section below, if Patient Client wishes to send email communications to and receive email responses from Company or Company Personnel, Patient Client acknowledges that email is not a secure medium for sending and receiving potentially sensitive personal health information.  Patient Client also acknowledges and understands that an email or secure message in any form is not a good medium for urgent or time-sensitive communications.  In the event a communication is time-sensitive, Patient Client must communicate with Company Personnel by phone or in person.  Patient Client acknowledges and understands that, at the discretion of Company Personnel, Patient Client’s email may become part of Patient Client’s medical record.

Notices

Any communication required or permitted to be sent under this Agreement shall be in writing and sent via U.S. mail or email to the addresses set forth in this Agreement.  Any change in address shall be communicated in accordance with this section; and Patient Client is solely responsible for updating Company with respect to any change of address (including email address.)

Non-Disparagement

In the event that a dispute arises between the Parties or a grievance by Patient Client, the Parties agree and accept that the only venue for resolving such a dispute shall be in the venue set forth herein below. In the event of a dispute between the Parties, the parties agree that they neither will engage in any conduct or communications, public or private, designed to disparage the other.

Indemnification

Patient Client shall defend, indemnify, and hold harmless Company, Company’s shareholders, trustees, affiliates, and successors from and against any and all liabilities and expense whatsoever - including without limitation, claims, damages, judgments, awards, settlements, investigations, costs, attorney’s fees, and disbursements - which any of them may incur or become obligated to pay arising out of or resulting from the offering for sale, the sale, and/or use of the product(s), excluding, however, any such expenses and liabilities which may result from a breach of this Agreement or sole negligence or willful misconduct by Company, or any of its shareholders, trustees, affiliates or successors. Patient Client shall defend Company in any legal actions, regulatory actions, or the like arising from or related to this Agreement.  Patient Client recognizes and agrees that all of the Company’s shareholders, trustees, affiliates and successors shall not be held personally responsible or liable for any actions or representations of the Company.

Controlling Agreement

In the event of any conflict between the provisions contained in this Contract and any marketing materials used by Company, Company’s representatives, or employees, the provisions in this Agreement shall be controlling.

Governing Law

This Agreement shall be governed by and construed in accordance with laws of the State of Delaware without regard to Delaware’s choice of law provisions.  The parties hereto agree to submit any dispute or controversy arising out of or relating to this Agreement to arbitration in the State of Delaware, New Castle County pursuant to the rules of the American Arbitration Association, which arbitration shall be binding upon the parties and their successors in interest.  The prevailing party is entitled to be reimbursed for all reasonable legal fees from the non-prevailing party in order to enforce the provisions of this Agreement.

Entire Agreement; Amendment

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 in the Agreement.  No amendment of this Agreement shall be binding on a party unless made in writing and signed by all parties.  Notwithstanding the forgoing, Company may unilaterally amend this Agreement to the extent required by law or regulation by sending Patient advance written notice of any such change; any such changes are incorporated into this Agreement by reference without the need for signature by the parties and are effective as the date established by Company.

Survivability

The ownership, non-circumvention, non-disparagement, proprietary rights, confidentiality, and indemnification provisions, and any provisions relating to payment of sums owed set forth in this Agreement, and any other provisions that by their sense and context the parties intend to have survive, shall survive the termination of this Agreement for any reason.

Severability

In the event that any provision of this Agreement, or application thereof, becomes or is declared by a court of competent jurisdiction to be illegal, void, or unenforceable, the remainder of this Agreement shall continue in full force and effect and the application of such provision to other persons or circumstances shall be interpreted so as reasonably to effect the intent of the Parties.  This Section shall survive termination or expiration of this Agreement.

Service Details

This Service includes one New Patient session, either in-person or via phone or internet. Each session is up to 90-minutes in duration, including up to 75-minutes face-to-face time and 15-minutes for Dr. Ritz to complete your recommendations.  

It is the Patient Client's responsibility to make sure we are covering what you prefer to be covered during each session within the 75-minute time-frame.  

It is the Patient Client's responsibility to schedule all sessions within a reasonable time-frame, and at a maximum within 6 months, or remaining sessions will be forfeited unless other arrangements have been made between Dr. Ritz and Patient Client in writing.

The investment for the Service payment-in-full amount is $750 (the “Fee”), with payment-in-full to be made at the time of registration.

In addition, Patient Client acknowledges understanding that Dr. Ritz does not contract with insurance companies for her services, and agree that you, the Patient Client, are willing to pay out-of-pocket for her services, and that any and all insurance reimbursement is the sole responsibility of you, the Patient Client.

You also acknowledge that there may be some additional investment for lab testing based on your individual insurance plan and that any investment for lab testing is the sole responsibility of you, the Patient Client.

 Private Patient Client Access

Materials used in this Service experience (may include Welcome Packet forms, schedules, documents, etc) will be housed conveniently on a secured and confidential "Private Patient Client Website". Upon enrolling for the program, you will be given a unique username and password.  At your convenience you may access this "Private Patient Client Website" area to access, review and/or update the forms, schedule, etc that we'll be using through your Service.  Company and/or Dr. Ritz will provide you with the access information and further instructions once you register for the Service if you haven't already been provided with this information.

 Practice Philosophy and Policies

By accepting this agreement, you the Patient Client acknowledge understanding of and agreement with the following practice philosophy and policies, which are designed to assist you in getting the most out of your Service.

Time:  Please note that we begin and end our sessions on time. We do understand that unanticipated events can sometimes throw things off, but we ask that you allow yourself plenty of time to arrive a few minutes early for each session so we can make the most of our time together. If there is an issue or concern that cannot be resolved in our allotted session time, it can be addressed in a future session.  If you, the Patient Client, are late to a session, you forfeit the missed session time.  

Service Engagement:  This Service is designed to have you, the Patient Client, fully engaged throughout the process.  It is your responsibility to complete any and all pre- and post-session forms as well as any exercises and action steps to ensure you receive the most benefit from the Service.

Spirit of Partnership:  Please know that we as a team are here to support you on your health journey and we have your best interests at heart. If at any time you have a question or concern about something, we ask that you approach Dr. Ritz or a member of her team with a spirit of partnership, realizing we are on your team and we are more than happy to address your question or concern, or direct you to a place where your question or concern can be best addressed.

As your physician coach, you can expect Dr. Ritz to:
1. Be a partner in bringing out the best, the deepest, and the truest in you
2. Provide safety, encouragement and support; an environment in which you can relax and explore
3. Respect the confidentiality of the agreements we make
4. Expand your view of what is possible and promote discovery of new insights
5. Give you input, straight feedback and operate as a sounding board
6. Listen carefully to what you say and ask questions that increase awareness
7. Be an on-going resource for you in accomplishing your intentions

Dr. Ritz expects that you, the Patient Client will:
1. Cultivate a core honesty with yourself
2. Commit yourself to intentions that are truly meaningful and significant to you

3. Be open to Dr. Ritz's feedback, and keep Dr. Ritz honestly informed as to what is and is not working for you
4. Take ownership of and 100% responsibility for your progress and your accomplishments
5. Take responsibility for being fully engaged in the Service, including completing any and all forms, exercises, and actions that will support you in creating your desired results 

 Other Terms

Upon execution by signing or by clicking “I Agree,” the Parties agree that any individual, associate, and/or assign shall be bound by the terms of THIS AGREEMENT. A facsimile, electronic, or e-mailed executed copy of this Agreement, with a written or electronic signature, shall constitute a legal and binding instrument with the same effect as an originally signed copy.