Common Contracts
1 similar Preferred Family Medicine Membership Agreement contracts
Preferred Family Medicine Membership AgreementPreferred Family Medicine Membership Agreement • August 10th, 2020
This Patient Agreement (“Agreement”) specifies the terms and conditions under which, you, the undersigned patient, Medicare beneficiary, or beneficiary’s representative (as applicable, “Patient”) may participate in certain integrative private direct health programs identified in the attached Schedule A (“Services”) offered by Christopher C. Highley D.O., PC dba Preferred Family Medicine (“Practice”). (Patient and Practice are referred to individually as “Party” or collectively as “Parties”). This Agreement between Practice and Patient will become effective on the date the Agreement is signed by Patient and payment is received. Practice’s Physician has formally opted out of Medicare and is out-of-network with any and all private or public health insurance plans (“Plan” or “Plans”). The patient shall pay privately and directly for all Services and will be unable to submit any Services fees to Medicare (or likely any Plan) for reimbursement.
