PATIENT SURGICAL AGREEMENT – TERMS & CONDITIONS

This Patient Surgical Agreement – Terms and Conditions (the “Agreement”) is made and entered into between the Company identified on the Invoice signed by Patient and the individual signing the Invoice (the “Patient”).

1. Services. This Agreement covers the performance of the services listed on Patient’s Invoice and on any subsequent Invoice(s) signed by Patient as well as any other services not listed in the Invoice(s) but which the Company reasonably determines need to be provided to Patient as a means of providing the services listed on the Invoice(s) (collectively, the “Services”).

2. Patient Financial Responsibility. Patient understands and agrees that payment for all Services provided to Patient and any additional fees assessed against Patient pursuant to the terms of this Agreement are the sole and absolute responsibility of Patient. Patient agrees to pay for the total amount of the Services, including any and all additional fees assessed against Patient pursuant to the terms of this Agreement.

3. Booking Fee; Time Frame.

3.1. In General. To schedule a surgery with Company, Patient shall pay the Booking Fee listed on Patient’s Invoice. The Booking Fee is NON-REFUNDABLE. The Booking Fee compensates Company for all expenses (administrative and otherwise) relating to all necessary work that has been undertaken from the time of Patient’s inquiry up through and including booking the Patient for surgery.

3.2. Time Frame. Upon payment of the Booking Fee, Patient shall have twelve (12) months from the date of payment of the Booking Fee to schedule and undergo surgery. Subject to the terms of this Agreement, if Patient’s surgery does not take place within twelve (12) months from the date of payment of the Booking Fee, then the Booking Fee shall be deemed forfeited, and a new Booking Fee shall be required. Additionally, depending upon the time frame in which a surgery is cancelled or rescheduled, there may also be additional fees and costs assessed against Patient pursuant to the terms of this Agreement.

3.3. Forfeiture. If Patient elects to forfeit Patient’s Booking Fee, then Patient shall not be permitted to schedule or reschedule any surgery at Company within 90 days of forfeiture.

4. Contract Changes Resulting in Additional Fees to Patient.

4.1. Change of Surgeon. Any change by Patient to the surgeon listed on the Invoice will result in a $1,000 change fee ONLY if Patient chooses a surgeon that is less expensive than the surgeon initially chosen by Patient as reflected in the Invoice. However, should the surgeon listed on Patient’s Invoice become unavailable and/or unable to perform Patient’s Services, then Company reserves the sole and absolute right to select a different surgeon to perform Patient’s Services at no additional cost to Patient. Any change of surgeon initiated by Company shall not serve as a basis for Patient to cancel or reschedule any of the Services.

4.2. Change of Surgery Date. Patient may reschedule his or her surgery without penalty with at least 60 days’ notice of the surgery date that is initially scheduled by Company. Should Patient reschedule Patient’s surgical procedure within 60 days of the original surgery date, then Patient understands and agrees that Patient shall be subject to a $500 rescheduling fee. Notwithstanding the above, in the event that a conflict or other such reason arises on the Company’s end with respect to Patient’s surgery date, Company reserves the sole and absolute right to change Patient’s surgery date at no additional cost to Patient. Company will take all reasonable steps to minimize any changes made by Company to Patient’s surgery date. Any change of surgery date initiated by Company shall not serve as a basis for Patient to cancel or reschedule any of the Services.

4.3. Change of Location. Once Patient has scheduled the Services, any change by Patient to the location in which the Services are to be performed will result in a $1,000 change fee. Company reserves the right to increase this fee at any time without prior notice to Patient. Notwithstanding the above, in the event that a conflict or other such reason arises on the Company’s end with respect to the location in which Patient is scheduled to undergo the Services, Company reserves the sole and absolute right to change the location at which Patient’s Services will be performed at no additional cost to Patient. Any change of location initiated by Company shall not serve as a basis for Patient to cancel or reschedule any of the Services.

4.4. Change of Services or Surgical Plan. If Patient elects to change the surgical plan, then Patient shall be subject to $500 change fee ONLY if the change results in a less expensive procedure than initially chosen by Patient as reflected in the Invoice. Additionally, Patient understands and agrees that, consistent with Section 13 of this Agreement, the recommended surgical procedure may be changed the day of surgery, subject to the surgeon’s discretion, which may result in additional costs to Patient. If Patient’s surgical procedure is changed the day of surgery pursuant to the surgeon’s recommendation, then Company will honor the retail price for that surgical procedure as of the date of Patient’s initial Invoice.

5. Problems and Complications Resulting in Additional Fees to Patient.

5.1. In General. Patient understands and accepts that problems relating to or complications arising from your surgery may result in additional fees and costs to be assessed against Patient. These costs may include additional anesthesia and facility fees, hospital costs, physician’s and surgeon’s fees and/or other charges. Patient is solely responsible for these fees and costs.

5.2. Cell Saver. Any patient with a hemoglobin level between 11.0 and 11.9, as determined by the laboratory results submitted to Company within the time frame required by Company, will require the use of Cell Saver. Notwithstanding, at the surgeon’s sole and absolute discretion, the surgeon may determine that the use of Cell Saver will be required for Patient’s surgery regardless of Patient’s hemoglobin level. Patient shall be responsible for paying the NON-REFUNDABLE $500 fee for the use of Cell Saver during Patient’s surgery. Failure by Patient to pay for Cell Saver prior to surgery will result in the cancellation of Patient’s surgery. Patient shall not be entitled to any refund of this fee if Cell Saver is not actually used on Patient during Patient’s surgery. The non-refundable nature of this fee is due to the costs associated with keeping Cell Saver on standby for Patient during Patient’s surgery.

6. Payment Options.

6.1. Direct Payments. Company accepts payments in cash (U.S. Dollars) and the following credit cards: Visa, Master Card, Discover, and American Express. Personal, business, or cashier’s checks ARE NOT ACCEPTED BY COMPANY. With respect to payment of the Booking Fee only, Patient may be permitted to pay the Booking Fee via money order, which must be sent at least 45 days before Patient’s scheduled surgery to the following address: 14000 SW 119th Ave Miami, FL 33186. Other than for payment of the Booking Fee, Company does not accept money order as a valid form of payment. If sending payment by mail, then Company recommends that Patient include a tracking number for Patient’s own safety and ability to track the payment. Company is not responsible for lost payments sent by mail. If a third party is paying on Patient’s behalf, that third party must provide a government issued identification AND a credit card that matches the name on the government issued identification. FAILURE TO COMPLY WITH THESE REQUIREMENTS WILL RESULT IN THE IMMEDIATE CANCELLATION OF PATIENT’S SURGERY AND PATIENT’S NON-REFUNDABLE BOOKING FEE SHALL BE DEEMED FORFEITED.

6.2. Payments Through Third-Party Lenders. Company requires that payments from finance companies be made no earlier than 30 days and no later than 10 days prior to the date of surgery. Please keep in mind that Company DOES NOT take payments from third-party lenders on weekends and that such payments can only be made during business hours Monday through Friday. Before Company will accept any financing payments, Patient must first send a legible copy of a valid government issued identification to Company, as instructed by Company. Additionally, Patient must be an authorized cardholder. If a third party is paying on Patient’s behalf, that third party must provide a government issued identification AND a credit card that matches the name on the government issued identification. FAILURE TO COMPLY WITH THESE REQUIREMENTS WILL RESULT IN THE IMMEDIATE CANCELLATION OF PATIENT’S SURGERY AND PATIENT’S NON-REFUNDABLE BOOKING FEE SHALL BE DEEMED FORFEITED.

6.3. Cash-Only Discount. Effective September 19, 2022, no Patient shall be eligible for a cash-only discount. For any Invoice issued to Patient prior to September 19, 2022, Company will honor any cash-only discount, if applicable, pursuant to the then-current Terms and Conditions.

6.4. Forfeiture of Monies. If Patient fails to undergo the surgical procedure stated in Patient’s Invoice within twelve (12) months from the date of payment of the Booking Fee, then ALL monies paid to Company shall be deemed forfeited by Patient and Company shall be entitled to retain ALL monies paid by Patient without any refund to Patient.

7. Deadline for Payment in Full. If making payment by means of one of the payment methods set forth in either Section 6.1 or 6.2 of this Agreement, then the cost of the Services and any fees assessed against Patient pursuant to the terms of this Agreement shall be due and payment shall be made in full at least 10 days prior to Patient undergoing surgery.

8. Disputes. Patient understands that if Patient or the card holder disputes any charges with a credit card or financing company that is for the correct amount as determined by the Company’s records, then Company reserves the right to cancel all Services, remove Patient from all appointments, and that Patient shall be deemed to have forfeited all payments made to Company. If Company decides to continue providing services to Patient, then Patient shall be required to make all future payments in cash, including a new cash-only Booking Fee, and that Patient shall not be eligible for the discount set forth in Section 6.3 of this Agreement.

9. Required Government Issued Identification. When identification is required of Patient by Company, the Patient must provide one form of a government issued identification which contains a picture and CANNOT BE EXPIRED. The forms of identification acceptable to Company include: (1) State issued Driver’s License; (2) State issued Non-Driver ID; (3) Government-issued passport; (4) Military identification; or (5) Government-issued Green Card/Resident Alien Card.

10. Pre-Surgical Laboratory Testing & Medical Clearances. Patient is required to have all laboratory results and medical clearance results submitted to Company within 45 to 60 days prior to Patient’s scheduled surgery date. If Patient’s surgery was scheduled less than 60 days but greater than 14 days from the scheduled surgery date, then Patient understands that the laboratory results and medical clearances must be expedited and submitted to Company by no later than 10 days prior to Patient’s scheduled surgery date. If Patient’s surgery was scheduled less than 14 days from the scheduled surgery date, then Patient understands that the laboratory results and medical clearances must be expedited and submitted to Company by no later than 72 hours prior to Patient’s scheduled surgery date. Company, as determined by one of its surgeons, reserves the right to request additional laboratory testing, additional medical clearances, or any other studies to deem Patient a candidate for surgery. Any additional testing, clearances, or studies requested by the surgeon shall be submitted to Company no later than the date specified to Patient by the Company (such as the labs department). Due dates are subject to change by the Company. Subject to the exceptions set forth in Section 21, failure to provide the requested laboratory results, clearances, or studies by the stated deadlines will result in the cancellation of Patient’s surgery without any refund of the Booking Fee. Patient is solely responsible for obtaining and paying for Patient’s medical clearances, laboratory testing, and any other studies, tests, or results requested by Company and/or the surgeon.

11. Pre-Surgical Requirements; Circumstances Resulting in Cancellation of Surgery; Additional Fees.

11.1. BMI Requirements for Surgery. For any surgery that INCLUDES a Tummy Tuck/Abdominoplasty, Patient MUST have a Body Mass Index (“BMI”) of 32 or less on the day of Patient’s pre-operative appointment. For any surgery that DOES NOT include a Tummy Tuck/Abdominoplasty, Patient MUST have a BMI of 34 or less on day of Patient’s pre-operative appointment. For the Awake Lipo surgical procedure, Patient MUST have a Body Mass Index (“BMI”) of 40 or less on the day of Patient’s pre-operative appointment. Patient’s surgery will be cancelled if Patient does not meet the BMI requirement on the day of Patient’s pre-operative appointment. At Physician’s medical discretion, Physician may elect to make exceptions to this baseline requirement. If Patient does not reschedule Patient’s surgery within the 12-month window provided by Section 3, then Patient shall be refunded all monies paid with the exception of the Booking Fee. If the 12-month window provided by Section 3 has elapsed, then Patient must be issued a new Invoice, including a new Booking Fee, to reschedule any services at the then-current rate, and any monies previously paid to Company (not including the Booking Fee) shall be applied towards the new Invoice.

11.2. Pregnancy Prior to Surgery. Patient is not authorized to undergo surgery if pregnant. Additionally, if Patient is diagnosed with a pregnancy that results in a failed pregnancy, miscarriage or termination at any time within 6 months of the scheduled date of surgery, then Patient’s surgery must be rescheduled within the time frame provided by Section 3. Additionally, Patient agrees to have a pregnancy test administered by Company on the day of surgery prior to the start of the surgery. In the event the test is positive, Patient’s surgery will be immediately cancelled. If Patient is cancelled the day of surgery due to a positive pregnancy test which was not already known to Patient, then Patient shall be required to pay a $1,000 cancellation fee. However, if Patient elects to reschedule the surgical procedure in lieu of requesting a refund, then Company agrees to waive the cancellation fee and any new Booking Fee and grant Patient a one-time courtesy 18-month contract extension to allow Patient to reschedule the surgical procedure.

11.3. Hemoglobin or A1C Levels. Any Patient with a hemoglobin level of less than 11.0 as determined by the laboratory results submitted to Company within the time frame required by Company will be cancelled and may be rescheduled by Patient within the time frame provided by Section 3. However, a Patient whose Services only include a Breast Augmentation may have a hemoglobin level of less than 11.0. Patient must not have an A1C level higher than 6.9 as determined by the laboratory results submitted to Company within the time frame required by Company, otherwise Patient’s surgery will be cancelled and may be rescheduled by Patient within the time frame provided by Section 3 of this Agreement.

11.4. Medications for Pre-Existing Conditions. If Patient has been diagnosed with a pre-existing medical condition that can be regulated or controlled, Patient must seek additional treatment from Patient’s primary doctor to control the condition, which may include taking prescribed medications, before scheduling or rescheduling Patient’s Services.

11.5. Drug Test. Patient agrees to have a drug test administered by Company on the day of surgery prior to the start of the surgery. In the event the drug test is positive, Patient’s surgery will be immediately cancelled, and all monies paid to Company shall be deemed forfeited without any refund to Patient. However, if Patient decides to reschedule the Services, then Patient shall be required to pay a $1,500.00 rescheduling fee.

11.6. Nicotine Test. Patient agrees to have a nicotine test administered by Company on the day of surgery prior to the start of the surgery. In the event the test is positive, Patient’s surgery will be immediately cancelled, and all monies paid to Company shall be deemed forfeited without any refund to Patient. At Physician’s medical discretion, Physician may elect to make exceptions to this baseline requirement. However, if Patient decides to reschedule the Services, then Patient shall be required to pay a $800.00 rescheduling fee.

12. Misrepresentation or Forgery of Medical Information. If Patient misrepresents or forges any medical information or medical records (including but not limited to medical clearances or laboratory results), as determined by Company, then Patient shall be deemed to have forfeited all payments made to Company and Patient shall be prohibited from receiving any services at or from Company.

13. Appointments & Pre-operative Visits. Patient will receive the time of surgery the day before surgery. Unless otherwise instructed by Company, Patient must be physically present in Company’s office for the pre-operative visit the day before the surgery for the completion of pre-operative paperwork, to receive any prescriptions, and to make a final payment in full for any amount outstanding. Patient understands that Patient’s surgical plan consists of a recommendation based on information and photographs provided by Patient and that, at the time of Patient’s exam in the office, it may be necessary to modify Patient’s surgical plan, which may involve additional costs. Subject to the exceptions set forth in Section 21, Patient’s failure to appear for the pre-operative visit will result in the immediate cancellation of Patient’s surgery and all monies paid to Company shall be deemed forfeited without any refund to Patient. Additionally, Patient understands and agrees that the recommended procedure may be changed the day of surgery, subject to the surgeon’s discretion, which may result in additional costs to Patient. Further, subject to the exceptions set forth in Section 21, if Patient fails to appear for the surgical procedure on the scheduled surgery date, all monies paid to Company shall be deemed forfeited without any refund to Patient. Company seeks to make the process as easy as possible without any compromise to Patient’s health or safety.

14. Post-operative Visits. Company recommends that Patient attend the following post-operative appointments in the location and with the surgeon that performed Patient’s Services: (i) first post-operative visit within one week of surgery; (ii) second post-operative visit four to six weeks after surgery; and (iii) third post-operative visit at three months after surgery. Company provides these three (3) post-operative visits with the surgeon free of charge. Patient will be charged $250 for each additional post-operative visit with the surgeon. However, should a medical complication arise, Patient may attend additional follow-up visits free of charge, subject to the surgeon’s discretion and authorization. Additionally, any post-operative visits with a nurse within three (3) months after surgery are free of charge. Patient will be charged $75 for any post-operative visit with a nurse after three (3) months from the date of Patient’s surgery date.

15. Caretaker Policy. Patient understands that Patient is responsible for ensuring that a caretaker of legal age (18 years or older) shall pick up Patient after Patient’s surgical procedure. The name and information of the individual caretaker shall be provided by Patient to Company prior to surgery. UNDER NO CIRCUMSTANCES SHALL A RIDE SHARE OR TAXI QUALIFY AS A CARETAKER. Patient understands that the effects of anesthesia and surgery make it necessary to have a proper caretaker and that this policy is mandatory to ensure Patient’s safety. Company will inform Patient’s caretaker when the surgery has ended, and caretaker must pick Patient up no longer than one hour after Patient’s surgery. IF PATIENT’S CARETAKER FAILS TO PROMPTLY PICK UP PATIENT WITHIN THE ONE-HOUR WINDOW AFTER SURGERY THEN COMPANY WILL CALL AN ABMULANCE OR EMERGENCY MEDICAL SERVICES COMPANY TO PICK UP PATIENT AND PATIENT SHALL BE RESPONSIBLE FOR THE COSTS.

16. Recovery Period After Surgery. Patient shall remain within 20 miles of the surgery location for a minimum of five (5) days after surgery to receive post-operative care. Failure to do so shall be considered leaving against medical advice.

17. Additional Non-Surgical Services.

17.1. Post-Surgical or Lymphatic Massages. Company may provide Patient with the option to purchase post-surgical or lymphatic massages to expedite recovery after surgery. Patient understands that this massage is not a traditional massage and will ONLY last 20 minutes. ALL MASSAGES ARE NON-REFUNDABLE.

17.2. Surgical Accessories. Surgical accessories are NON-REFUNDABLE and NON-TRANSFERRABLE (i.e., they may not be transferred by Patient to another person).

18. Additional Fees Imposed Upon Patient. Any additional fees assessed to and imposed upon Patient, including but not limited to a rescheduling fee, cancellation fee, surgeon fee, and/or change fee, are in addition to the costs of the Services and shall NOT be applied towards the cost of any Services. Company reserves the right to increase these fees at any time without prior notice to Patient. These additional fees are determined by the Company at its sole and absolute discretion.

19. Touch-Up Policy.

19.1. In General. All plastic surgery treatments and operations are performed to improve an unsatisfactory area on Patient’s body with a very high probability of success. Patient must understand that the outcome of the procedure is dependent upon various factors, many of which are outside of Company’s control. To that end, Patient must be realistic in the outcome likely to be achieved by Patient based on Patient’s body type, Patient’s history and other factors within Patient’s sole control. Notwithstanding, Company understands that a Patient may not always achieve the desired result. In certain cases, the surgeon that performed Patient’s surgery, in his/her sole discretion, may elect to provide a touch-up procedure to Patient within one (1) year from the date of Patient’s surgery, which shall be subject to the fees and costs set forth herein. However, if after approving a touch-up procedure, the surgeon that performed Patient’s surgery is no longer employed by Company, then Patient shall not be entitled to receive a touch-up procedure.

19.2. Fees & Costs. If the touch-up procedure by the surgeon that performed Patient’s initial procedure requires Patient to be placed under general anesthesia, as determined by the sole discretion of the surgeon, then: Patient shall be required to pay an operating fee between $1,500-$3,000, which includes the costs for the operating room and general anesthesia. If the touch-up procedure by the surgeon that performed Patient’s initial procedure does not require Patient to be placed under general anesthesia, but can instead be performed under local anesthesia, as determined by the sole discretion of the surgeon, then: Patient shall be required to pay a $750-$1,500 operating fee, which includes the costs for the operating room and local anesthesia.

19.3. Exclusions; Additional Fees & Costs. Any touch-up procedure does NOT include any additional services that were not part of the initial surgical procedure or any products or materials utilized by the surgeon to give the Patient the desired result (including, but not limited to, an implant, upgraded implant or mesh). Additionally, before undergoing a touch-up procedure, Patient must still comply with all laboratory tests and medical clearances required by the terms of this Agreement. Further, Patient may be required to pay additional fees required by Section 5.2 (Cell Saver) in connection with the touch-up procedure. Company is not responsible for any fees or costs relating to a touch-up procedure.

20. Medical Records including Pre-Op and Post-Op Pictures. If Patient requests medical records, including but not limited to pre-operative or post-operative photographs taken by Company, Patient shall be responsible for paying an administrative fee of $25.00.

21. Cancellation & Refund Policy; Exceptions.

21.1. In General. Company understands that situations arise that may force Patient to postpone Patient’s Services. Patient must understand that such changes affect the surgeon, operating room staff, Company staff, and other patients. The surgeon’s time, as well as that of the operating room staff’s, is precious and Company requests Patient’s courtesy and concern.

21.2. Policies. The following are the Company’s cancellation and refund policies, which are subject to the terms and conditions as set forth in this Agreement:

1. The Booking Fee is not refundable at any time, for any reason.

2. If the surgeon or CRNA/anesthesiologist cancels Patient for a medical condition that was unknown to Patient that disqualifies Patient from surgery, then Patient shall be entitled to receive a complete refund, exclusive of the Booking Fee, upon receipt of proper medical documentation as determined by Company. However, if Patient is cancelled the day of surgery due to a medical condition that was discovered by the surgeon or CRNA/anesthesiologist that was known to and not disclosed by Patient, then Patient will not be eligible for any refund.

3. No refund shall be issued for any cancellation by Company on the day of surgery due to Patient’s withholding of medical information or failure to follow pre-operative instructions, as determined by Company.

4. If Patient is cancelled the day of surgery due to a positive pregnancy test which was not already known to the Patient, then Patient shall have two options: (1) Patient shall be entitled to receive a full refund, exclusive of a $1,000 cancellation fee and exclusive of the Booking Fee; or (2) Patient shall be entitled to a one-time courtesy 18-month contract extension to allow Patient to reschedule the surgical procedure. If Patient elects to proceed with the rescheduling of the surgery (i.e., the second option) then Patient understands that, should cancellation occur for any reason, Patient shall be required to pay a $1,000 cancellation fee.

5. If Patient fails to provide the requested laboratory results, clearances, or studies by the stated deadlines which in turn causes the surgery to have to be cancelled or rescheduled, then all monies paid to Company shall be deemed forfeited and Patient shall not be eligible for any refund.

6. If Patient fails to appear for the surgical procedure on the scheduled surgery date, then all monies paid to Company shall be deemed forfeited without any refund to Patient.

7. If Patient fails to appear for the scheduled pre-operative visit, then all monies paid to Company shall be deemed forfeited without any refund to Patient.

8. If Patient fails to obtain the necessary medical clearances due to a medical condition, then Patient shall be entitled to a complete refund of all monies paid to Company, exclusive of the Booking Fee.

9. If the doctor determines on the day of surgery that Patient is not a candidate for surgery based on the information previously provided by the patient through the labs and clearance process, then Patient shall be entitled to a complete refund of all monies paid to Company, exclusive of the Booking Fee.

10. If, due to clear Company oversight based on the medical documentation in Company’s possession, Patient was erroneously cleared for surgery, then Patient shall be entitled to a complete refund of all monies paid to Company, exclusive of the Booking Fee.

11. If Patient paid for a massage that Patient did not receive as a result of Company’s inability to schedule or reschedule Patient, then Patient shall be entitled to receive a refund for the amount of such massage(s).

12. If Patient paid for a surgical procedure that that Patient did not receive due to the medical discretion of the surgeon (i.e., Patient paid for liposuction of the abdomen and arms, but did not ultimately receive liposuction of the arms), then Patient shall be entitled to receive a refund for the amount of the surgical procedure that was not received by Patient.

21.3. Exceptions. To follow are the exceptions to the Company’s cancellation and refund policies, as set forth in this Agreement:

1. If Patient failed to comply with any requirement to proceed with surgery, and such failure occurred as a direct result of a recent death (i.e., within the past 7 days) to Patient’s immediate family member (i.e., mother, father, brother or sister), then, Patient shall be required to disclose such and provide Company with a copy of the Death Certificate in order to avoid any forfeiture of monies or additional rescheduling fees being imposed upon Patient.

2. If Patient failed to comply with any requirement to proceed with surgery, and such failure occurred as a direct result of Patient having been deployed by any branch of the United States military, then, Patient shall be required to disclose such and provide Company with a copy of official and proper documentation demonstrating Patient’s deployment in order to avoid any forfeiture of monies or additional rescheduling fees being imposed upon Patient.

21.4. Time Frame for Issuance of Refund. Processing eligible refunds may take 45 days or more to be issued.

22. No Warranty. Patient recognizes that the practice of medicine and surgery is not an exact science and understands and accepts that fees are paid for performance of the Services only, and NOT A GUARANTEED RESULT. Patient acknowledges that although a good outcome is expected, and a reasonable effort has been made to establish realistic expectations, COMPANY DOES NOT GIVE ANY WARRANTY, EXPRESSED OR IMPLIED, AS TO THE RESULTS THAT MAY BE OBTAINED.

23. Disclaimer of Liability for Third-Party Products & Services. AS PART OF ITS SERVICES TO PATIENT, COMPANY MAY OFFER THIRD PARTY PRODUCTS AND SERVICES. COMPANY DISCLAIMS ANY AND ALL LIABILITY, INCLUDING ANY EXPRESS OR IMPLIED WARRANTIES, WHETHER ORAL OR WRITTEN, FOR SUCH THIRD-PARTY PRODUCTS AND SERVICES. PATIENT ACKNOWLEDGES THAT NO REPRESENTATION HAS BEEN MADE BY COMPANY AS TO THE FITNESS OF THE THIRD-PARTY PRODUCTS OR SERVICES FOR PATIENT’S INTENDED PURPOSE. PATIENT AGREES TO HOLD COMPANY AND ALL OF ITS EMPLOYEES, DIRECTORS, OFFICERS AND AFFILIATES HARMLESS FROM ANY DAMAGES, LOSSES, CLAIMS, OBLIGATIONS, LIABILITIES, COSTS, AND EXPENSES ARISING FROM ANY THIRD-PARTY PRODUCTS OR SERVICES.

24. Governing Law and Alternative Dispute Resolution for Professional Liability and Medical Care-Related Claims. The Parties agree that any professional liability claim or dispute, including claims for professional negligence, medical malpractice, personal injury or death arising out of or relating to any medical or patient services rendered under or in connection with this Agreement, including any such claims against the Company or its affiliates, employees, agents, or physicians, physicians’ assistants, nurses or other health care providers employed by or affiliated with the Company, shall be governed by the laws of the State of Texas.

The Parties further agree that any such claims or disputes shall be resolved by MANDATORY AND BINDING ARBITRATION, in accordance with the Federal Arbitration Act (9 U.S.C. Section 1, et seq.) which shall apply to any such proceedings, including any actions to compel, enforce, vacate or confirm proceedings, awards, or orders of an arbitrator.

Both Parties to this Agreement confirm that they are entering into this BINDING ARBITRATION AGREEMENT on the advice of their respective counsel. Further, the Parties agree that the services provided under this Agreement and subject to this arbitration agreement involve and affect interstate commerce.

Patient further acknowledges that by entering into and accepting this Agreement, the Patient is giving up any right he/she may have to sue or bring any claim in a court of law. Patient acknowledges that he/she is giving up constitutional rights to have his/her claims decided in a court of law or before a jury and instead accepts the use of BINDING ARBITRATION as the EXCLUSIVE means to resolve such disputes.

This Agreement shall bind the Parties, their heirs, successors, assigns and all claimants whose claims may arise out of or are related to treatment or services provided under this Agreement by the Company and its employees, agents, and any affiliated physicians providing health care or professional services to the Patient.

A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in a civil action, would be barred by the applicable Texas statute of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures prescribed herein with reasonable diligence.

The Parties further agree that instituting legal proceedings in any court by the Company or its affiliates to collect any fee or outstanding invoice owed as a result of the services provided under this Agreement shall not constitute a waiver of the right to arbitrate under this paragraph.

Notice of Arbitration: A demand for arbitration must be communicated in writing by U.S. mail, postage prepaid, to all Parties, describing the claim against the Company, the amount of damages sought, and the names, addresses and telephone numbers of the Patient, and (if applicable) his/her attorney.

Selection of Arbitrator: A single arbitrator will be designated to preside over the arbitration proceedings. The Parties shall make good faith efforts to jointly agree upon an arbitrator. The Arbitrator shall reside or have a principal place of business in one of the following Texas Counties: Collin County or Rockwall County. If the Parties are unable to agree on an arbitrator, then each of the Parties to the arbitration proceeding shall designate three (3) proposed arbitrators. Each Party will be able to veto or strike one proposed arbitrator and the names of the remaining four (4) proposed arbitrators shall be submitted to a Texas state court judge in Collin County, Texas who shall select a single arbitrator from the remaining proposed names to serve as the arbitrator. Alternatively, only upon agreement of both Parties, the Parties may agree to select an arbitrator from the remaining proposed names by any agreed method of chance. As an additional alternative, if the Parties are unable to agree to an arbitrator who resides or has a principal place of business in one of the aforementioned counties, only upon agreement of both Parties, the Parties may jointly agree to an arbitrator who resides or has a principal place of business in Texas.

Location of Arbitration: Arbitration shall take place in one of the following Texas Counties: Collin County or Rockwall County as prescribed by the arbitrator, or in any other County in the State of Texas upon the agreement of all Parties involved in the arbitration proceeding.

Authority of Arbitrator: The arbitrator shall render a binding and legally enforceable award that may be confirmed by a court of competent jurisdiction upon application of the prevailing party. Any decision rendered by the arbitrator shall be binding upon both Parties except that the arbitrator may not grant any relief that is inconsistent with the provisions of this Agreement and may not grant punitive or exemplary damages as a result of any claim.

Each Party retains the right to seek judicial assistance to: (i) compel arbitration; and (ii) enforce any decision of the arbitrator, including the final award.

Cost of Arbitration and Recoverable Attorney Fees – Each Party to the arbitration shall bear their own costs, fees, and expenses. The arbitrator’s fees and expenses and any associated arbitration costs shall be split by the Parties as follows: Plaintiff(s) are collectively responsible for 50% and Defendant(s) are collectively responsible for 50%.

In the event any provision(s) of this Agreement is declared void and/or unenforceable, such provision(s) shall be deemed severed therefrom and the remainder of the Agreement enforced in accordance with the law of the state of jurisdiction.

25. Litigation and Governing Law of Any and All Other Claims. It is agreed and understood by the Parties that any controversy, dispute, claim or question, with the exception of those outlined in Paragraph 24, arising out of, or in connection with, or in relation to, this Agreement, breach of contract, billing, and any other claim not involving professional negligence, medical malpractice, personal injury or death, shall be decided by a court of law and brought in the State or Federal Courts located in Miami-Dade County, Florida. Any claims which are subject to litigation pursuant to this Paragraph 25 shall be governed by and construed in accordance with laws of the State of Florida without regard to conflicts of laws principles thereof. The rule of construction that ambiguities in an agreement shall be construed against the drafting party shall not apply to this Agreement. Additionally, any waiver by any party hereto of a breach of any provision of this Agreement shall not operate or be construed as a waiver of any other provision hereof. The Parties further agree that such courts located in Miami-Dade County shall be the exclusive courts of jurisdiction and venue for any litigation which the Parties may file for any action that is not subject to arbitration under Paragraph 24. Patient hereby submits to the exclusive jurisdiction of the State and Federal Courts located in Miami-Dade County, Florida and waives any claim that such court does not have jurisdiction over Patient, or that such jurisdiction is an inconvenient forum.

26. Class-Action Waiver; Group Action Waiver; Anti-Consolidation. PATIENT AND COMPANY AGREE THAT EACH MAY BRING CLAIMS AGAINST THE OTHER ONLY IN PATIENT OR COMPANY’S INDIVIDUAL CAPACITY AND NOT AS A CLAIMANT, PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS-ACTION, GROUP ACTION OR REPRESENTATIVE ACTION. ADDITIONALLY, NO ARBITRATOR OR JUDGE SHALL BE PERMITTED TO CONSOLIDATE MORE THAN ONE PERSON’S CLAIMS OR OTHERWISE PRESIDE OVER ANY FORM OF ANY REPRESENTATIVE OR CLASS PROCEEDING.

27. Prevailing Party Attorney’s Fees. In any litigation proceeding pursuant to Paragraph 25, the prevailing party shall be entitled to recover all court costs and reasonable attorneys’ fees from the date the action was filed through all levels of appeal.

28. Limitation of Liability. Company is not liable for Patient’s traveling expenses under any circumstances. ADDITIONALLY, IN NO EVENT SHALL THE COMPANY BE LIABLE TO PATIENT OR ANY THIRD PARTY FOR ANY GENERAL, SPECIAL, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES (INCLUDING, WITHOUT LIMITATION, INDIRECT, SPECIAL, PUNITIVE, OR EXEMPLARY DAMAGES FOR LOSS OF BUSINESS, LOSS OF PROFITS, OR BUSINESS INTERRUPTION) ARISING OUT OF OR CONNCTED IN ANY WAY WITH THIS AGREEMENT, PATIENT’S SERVICES, PATIENT’S INVOICE(S), PATIENT’S RELATIONSHIP WITH THE COMPANY AND/OR ANY SERVICES RENDERED BY THE COMPANY. THE TOTAL LIABILITY OF THE COMPANY TO PATIENT FOR ALL DAMAGES, LOSSES AND CAUSES OF ACTION (WHETHER IN CONTRACT, TORT (INCLUDING BUT NOT LIMITED TO NEGLIGENCE), OR OTHERWISE) SHALL NOT EXCEED THE TOTAL FEES PAID BY PATIENT DURING THE TWELVE (12) MONTHS IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO LIABILITY, EXCLUDING THE BOOKING FEE.

Last Updated: January 20, 2023