This CLIENT SERVICES AGREEMENT (this “Agreement”), dated by and between (“Client”) and [Dr. Takashi Nakamura] , a Missouri [Board Certified Physician] of (“MalCole Drip and Beauty Bar LLC”).
Service Provider and Client desire to enter into this Agreement to set forth the terms and conditions on which Service Provider will provide services to Client from time-to-time. Therefore, in consideration of the mutual promises contained herein, the parties hereto agree as follows:
1. SERVICES. MalCole Drip and Beauty Bar, LLC ( MalCole ) may administer intravenous hydration therapy, intramuscular injection therapy, or other therapies MalCole offers in the future.SERVICES.
MalCole Drip and Beauty Bar, LLC (MalCole) may administer intravenous hydration therapy, intramuscular injection therapy, or other therapies
MalCole offers in the future.
2. MEDICAL CONDITIONS. Medical Condition. Client understands, represents, and warrants that Client is not pregnant and does not have heart, kidney, lung, liver, or any neurological problem(s). Client understands and agrees that if Client has any of the aforementioned conditions, Service Provider will be unable to provide services to Client. Client understands, represents, and warrants that Client has spoken with his or her primary care physician and received approval to obtain the Services.
3. RIGHT TO REFUSE SERVICE. MalCole may refuse care or services based onMalCole’s provider’s professional opinions. MalColeproviders also have the right (but not the obligation) to call 911 or refer you for further medical attention.
4. RESULTS. Each individual is different. You acknowledge there is NO GUARANTEE as to results from the servicesMalColeprovides, and that the services may not provide the result you seek and expect.
5. ASSUMPTION OF RISK. You understand and agree that intravenous access or intramuscular injections come withpotential risks. These risks include but are not limited to: allergic reaction, infection,discomfort, bruising, pain, inflammation, phlebitis, metabolic disturbances, hypothermia, embolism, cardiac arrest, and even death. You knowingly, voluntarily, and fully assume the risks associated with obtaining services from MalCole Drip and Beauty Bar.
6. SCHEDULING AND CANCELLATION. Your time is valuable. We try to stay on schedule, so you and other patients don’t have to wait. If you are more than 10 minutes late for your appointment, we may reschedule you. Because MalCole reserves any requested and agreed upon time and date for you to receive services, MalCole asks for a deposit when making an appointment. If you cancel an appointment with more than 24 hours’ notice, you will receive a full refund of the deposit. If you cancel an appointment with notice of 24 hours or less, your deposit is forfeit and you will not receive a refund.
8. CONSENT FOR CARE. You, with your signature, authorize this practice, and any staff member working under the direction of the medical provider, to provide medical care for me, or to this patient for which you are the legal guardian. This medical care may include services and supplies related to your health (or the identified person) and may include (but is not limited to)intravenous hydration services and intramuscular injection services. This consent includes contact and discussion with other health care professionals for care and treatment.
9. DISPUTE RESOLUTION. You agree to provide MalCole with written notice of any dispute, claim, or controversy (Claim), of any sort or nature, arising out of the services MalCole provides, or with MalCole’s staff, within 6 months after any such claim, dispute or controvery arises. Any failure to strictly follow the procedures stated in this section shall constitute an unconditional WAIVER of any Claim that may exist or you have against MalCole or anyone affiliated with MalCole. You agree to pay MalCole’s reasonable attorneys’ fees for defending a lawsuit in which the dispute resolution procedure stated herein has not been strictly followed.
10. RELEASE AND INDEMNITY. YOU RELEASE MALCOLE, ITS OWNERS, MEMBERS, OFFICERS, MANAGERS, AGENTS, CONTRACTORS, EMPLOYEES, LICENSEES, AND INVITEES (MALCOLE GROUP) FROM ANY AND ALL LIABILITY FOR, AND AGREES TO INDEMNIFY AND HOLD SERVICE PROVIDER GROUP HARMLESS FROM AND AGAINST, ANY AND ALL LOSSES, CLAIMS, EXPENSES, COSTS, AND DAMAGES, INCLUDING BUT NOT LIMITED TO REASONABLE ATTORNEYS’ FEES, COSTS, OR EXPENSES, WHICH ARE CLAIMED OF OR SUSTAINED, SUFFERED, PAID, OR INCURRED BY MALCOLE GROUP, IRRESPECTIVE OF MALCOLE GROUP’S NEGLIGENCE (EXCEPT GROSS NEGLIGENCE), FOR REASON OF OR IN CONNECTION WITH (A) YOUR DECISION TO REQUEST OR RECEIVE THE SERVICES, (B) MALCOLE’S PERFORMANCE OF THE SERVICES, OR (C) YOUR BREACH OF OR FAILURE TO FULFILL ANY PROVISION OF THIS AGREEMENT, WHETHER SUCH BREACH IS MATERIAL OR NOT. YOU ASSUME FULL LIABILITY FOR ANY ADVERSE EFFECTS THAT MAY RESULT FROM THE ADMINISTRATION OF THE SERVICES AND WAIVE ANY CLAIM IN LAW OR EQUITY FOR REDRESS OF ANY GRIEVANCE THAT YOU MAY HAVE CONCERNING OR RESULTING FROM THIS PROCEDURE.
11. LIMITATION OF LIABILITY. NEITHER MALCOLE NOR ANY OF ITS AFFILIATES, OWNERS, MEMBERS, MANAGERS, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES, OR CONTRACTORS (EACH A “RELATED PARTY” AND, COLLECTIVELY, THE “RELATED PARTIES”) SHALL BELIABLE FOR ANY LOSS, LIABILITY, DAMAGE, OR EXPENSE ARISING OUT OF OR IN CONNECTION WITH THE SERVICES, UNLESS SUCH LOSS, LIABILITY, DAMAGE, OR EXPENSE SHALL BE PROVEN TO RESULT DIRECTLY FROM THE WILLFUL MISCONDUCT OR GROSS NEGLIGENCE OF SUCH PERSON. NONE OF THE RELATED PARTIES SHALL BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES (EVEN IF SERVICE PROVIDER HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES). IN NO EVENT WILL THE AGGREGATE LIABILITY OF MALCOLE, ITS OWNERS, MEMBERS, MANAGERS, OFFICERS, EMPLOYEES, AGENTS, AND CONTRACTORS FOR ANY AND ALL OF CLIENT’S CLAIMS, OR ANY THIRD PARTY CLAIMS, AGAINST MALCOLE AND/OR ITS OWNERS, MEMBERS, MANAGERS, OFFICERS, EMPLOYEES, AGENTS, AND CONTRACTORS, ARISING OUT OF OR RELATED TO, DIRECTLY OR INDIRECTLY, THE PERFORMANCE OR NONPERFORMANCE OF ANY SERVICES OR BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF MALCOLE, EXCEED THE GREATER OF (A) THE AMOUNT OF FIVE HUNDRED DOLLARS ($500.00) OR (B) THE FEES ACTUALLY PAID TO SERVICE PROVIDER HEREUNDER. YOU AGREE THAT THIS LIMITATION OF LIABILITY REPRESENTS A REASONABLE ALLOCATION OF RISK. THIS ALLOCATION OF RISK IS A FUNDAMENTAL ELEMENT OF THIS AGREEMENT.
[Dr. Takashi Nakamura]
Jessica Malone, RN
Title: Authorized Signatory