This agreement ("Agreement") is entered into between Root Causes Medical Clinic ("RCM") and the undersigned individual(s) (“Member(s)”) for the provision of healthcare services.
SERVICES: According to the member level, the membership fee may cover office visits, tele-health visits; and answers to many of your healthcare concerns via patient portal messages, texts, emails and phone calls. Membership fees may also include preferred and discounted access to select RCM treatment modalities and services as availability allows. No membership level includes office visits, tele-health visits or phone calls with our physician staff.
Limited Access members may select a remote coaching option which includes consulting services with a team of qualified professionals. These members are not required to be seen in person. Visits will be conducted by telephone or Zoom only. Lab interpretation and prescription services will require the Limited Access Membership with Medical Direction option or Standard Access Membership, also requiring one in-person visit per calendar year.
TERM: All memberships are for a period of six months beginning on the date of signing this Agreement and are subject to change.
FEES: There are three membership options. (Please change the dropbox below to select the plan you wish to choose.)
$100/Month for Limited Access Membership with Coaching Only
(Includes one visit with a Naturopathic Doctor and one visit with a Nutritionist every six months for remote coaching only. Does not include lab interpretation or prescription services.)
$100/Month for Limited Access Membership with Medical Direction
(Includes one visit with a Naturopathic Doctor and one visit with a Nutritionist every six months, and requires one in-person visit per year for lab interpretation and prescription services.)
$300/Month for Standard Access Membership
(Includes two visits with a Naturopathic Doctor every six months or up to one visit a month with a Nurse Practitioner, one visit with a Nutritionist every month, and requires one in-person visit per year for lab interpretation and prescription services.)
PAYMENT: Member agrees to pay RCM the contracted payment price for the six month period in interest-free monthly installments. Payment will be automatically charged to the credit card on file on a recurring basis or may be paid in full by electronic check. Any changes to payment information must be provided to Root Causes in writing at least 10 business days before the next payment is due. If any of the monthly installments charged by RCM are declined or otherwise go unpaid, Member agrees to correct the situation within 10 business days. If Member fails to do so, this Agreement will be deemed cancelled and the provisions of the following paragraph will apply.
CANCELLATION: Member may cancel this Agreement by providing written notice to RCM at least 30 days before the next payment is due. If Member cancels before the end of the chosen term of the agreement, RCM will charge Member for any unpaid installments due under the current membership agreement. If Member wishes to re-enroll after canceling, the re-enrollment fee will require the next six monthly installments to be paid in full upon signing, at the membership rates then in effect, which may be higher than the original contracted price.
MISCELLANEOUS: This Agreement constitutes the entire understanding between the parties and supersedes all prior negotiations, understandings, and agreements between them. This Agreement may be amended only in writing signed by both parties. This Agreement shall be binding upon and inure to the benefit of the parties and their respective successors and assigns. This Agreement shall be governed by and construed in accordance with the laws of the State of Texas. Any disputes arising out of or relating to this Agreement shall be resolved in accordance with the arbitration rules of the American Arbitration Association. By signing below, Member acknowledges that he/she has read and understands this Agreement and agrees to be bound by its terms and conditions.