1. FMA Description
1.1. The FMA provides access to services that are not covered by typical health insurance, such as those related to integrative and functional medicine and integrative and functional medicine resources provided by third-parties.
1.2. The FMA is not insurance or a medical discount plan.
1.3. SFM offers products and services that are not included in the FMA.
1.4. SFM is not responsible for third-party products and services.
1.5. FMA payments are processed up to three days before the Patient’s initially scheduled appointment and every month thereafter.
1.6. FMA payments are nonrefundable.
1.7. The services accessed by the FMA are subject to change without notice and may be removed at any time.
1.8. There may be additional costs to receive FMA services that are payable by Patient and due at the time services are rendered.
1.9. SFM may provide Patient’s information to third-parties for the purpose of marketing integrative and functional medicine products and services.
1.10. Patient may opt out from sharing information for marketing in Section 1.10 by notifying SFM in writing by email (email@example.com).
2. Patient Responsibilities
2.1. Patient is responsible for accessing the services provided by the FMA upon execution of the FMA.
2.2. Patient will identify to SFM staff that they have an FMA on file with SFM when accessing products and services.
2.3. Patient will pay for all FMA products and services at the time services are rendered.
2.4. Patient will make FMA payments to remain in good standing.
2.5. Patient must provide a credit card or banking information for recurring FMA payment.
2.6. Patient must provide an email account for FMA correspondence.
2.7. Patient will notify SFM of any changes of residency, insurance or payment information.
2.8. Failure to keep the FMA in good standing can result in Termination in accordance with Section 5 below.
3.1. FMA products, services and their cost may be changed at any time.
3.2. The price of the FMA payments may be changed with 90-day notice, with notice provided to the Patient at their email address on file.
4.1. The FMA may be terminated by Patient by notifying SFM in writing PRIOR to the beginning of the month for which payment is due by email at firstname.lastname@example.org.
4.2. The FMA may be terminated by SFM if Patient fails to make FMA payments.
4.3. A processing fee will apply for Patient to enter into an FMA within six months of terminating a previous FMA.
4.4. SFM may terminate the FMA at any time, with Patient receiving notice of termination of the FMA and a prorated refund of any period remaining for which payment has already been made.
5.1. The laws of the State of Nevada shall govern the validity of this Agreement, the construction of its terms and the interpretation of the rights and duties of the parties hereto.
5.2. Any controversies arising out of the terms of this Agreement or its interpretation shall be settled in Nevada by binding arbitration in accordance with the rules of the American Arbitration Association, and the judgment upon award may be entered in any court having jurisdiction thereof.
5.3. Patient may not assign the FMA to another party.
5.4. The FMA is assignable by SFM only to a successor professional corporation.
5.5. Should any provision of this Agreement be held invalid, unenforceable, or unconstitutional by any governmental body or court of competent jurisdiction, such holding shall not diminish the validity or enforceability of any other provision hereof.
5.6. This Agreement constitutes the entire agreement between the parties pertaining to the FMA between Patient and SFM and supersedes all prior or contemporaneous agreements, understandings, or negotiations of the parties, but may be amended in by SFM per notice included in 3.2.
5.7. Patient agrees to indemnify and hold harmless SFM from and against, but not limited to, all losses, claims, damages, errors, expenses or liabilities arising from the administration of the FMA and patient’s use of any third-party products or services.
5.8. Patient authorizes Sparks Family Medicine, Ltd and its third-party vendors, (currently Hint Health) to send email or text which may include unencrypted protected health information related to patient status, supplement purchases and FMA payment.
6. Enrollment Information
6.1. The FMA is $350 for initial registration and $100 a month. These payments are in addition to the normal and routine charges for the visit and are payable in advance of the visit.
6.2. Patient’s credit card or bank on file will be charged up to three days before the Patient’s initially scheduled appointment and every month thereafter, unless Termination is provided by Patient in accordance with Section 4.1.
FMA enrollment payments are nonrefundable.