PRIVATE PRACTICE- PATIENT AGREEMENT

This Private Practice- Patient Agreement (“Agreement”) specifies the terms and conditions under which, you the undersigned patient (“Patient”) may voluntarily elect to participate in the healthcare services offered by True You Health and Wellness a Professional Limited Liability Company as described in Schedule A and summarized as follows:

• Practice’s comprehensive integrative/Functional Medicine diagnostic routine exam services, provided on a regardless of medical condition or necessity basis, with follow up routine diagnostic exams as further specified (collectively “Integrative Exams”); and
• An online health data storage and communication facilitation platform plan designed to provide efficient and reliable electronic communication and health data storage support for Integrative Exams and to help Patient achieve Integrative Exams - bases health goals (“Health Data Services”). Integrative Exams and the Health Data Services described described in Schedule A are collectively the “Integrative Exam Services” and Patient and Practice are referred to individually as “Party” or collectively as “Parties.”

INTEGRATIVE EXAM SERVICES

Practice makes Integrative Exam Services available to Patient in exchange for Patient’s payment of the program subscription fees outlined in Schedule A (“Services Fees”). Service Fees may increase from time to time with Patient’s voluntary consent in advance but will apply to renewal terms. If Service Fees increase, Practice will notify Patient with the option to consent to increase.

Practice reserves the right to update the Integrative Exam Services in Schedule A from time to time, and if it does, Practice will notify Patient of any changes within thirty (30) days after a change is made and shall secure Patient’s voluntary consent to any such modification. Integrative Exam Services exceed or are beyond those covered by Patients Medicare, Medicaid, or private insurance plan (collectively “Plan”). Because Integrative Exam Services include integrative/Functional Medicine alternatives, Patient provides informed consent to such services as documented in the attached Schedule B.

Patient may pay the Services Fees with a credit card, health savings account (“HSA”) , flexible spending account (“FSA”) or health reimbursement account (“HRA”) funds, but Patient must confirm eligibility with Patients tax expert or plan coordinator as Practice cannot guaranty eligibility. Service Fees cover the availability of the Integrative Exam Services selected by and subscribed to by Patient for a period of one (1) year.

PAYMENT OPTIONS

Patient may pay the Services Fees with a credit card, health savings account (“HSA”) , flexible spending account (“FSA”) or health reimbursement account (“HRA”) funds, but Patient must confirm eligibility with Patients tax expert or plan coordinator as Practice cannot guaranty eligibility. Service Fees cover the availability of the Integrative Exam Services selected by and subscribed to by Patient for a period of one (1) year.

PAYMENT FOR LABS, OTHER STUDIES AND MEDICATIONS

Practice is not an insurer and cannot guarantee that the cost of labs, other studies nor medications will be covered by your insurance. Please contact your insurance if you have any questions regarding your coverage.

RENEWALS AND TERMINATION

This Agreement will automatically renew one (1) year from the date of this Agreement unless the Practice receives written notice from the Patient to terminate this agreement. The Practice is permitted to terminate this Agreement with thirty (30) days prior notice to Patient, in which case the Patient will receive a prorated refund of the Services Fees but the delivery of any Integrative Exams renders the Services Fees substantially earned by the Practice.