• Personal MD Cancelation Form

    Personal MD Cancelation Form

  • Termination Agreement: Personal M.D. Family Healthcare, P.A. (Personal MD) Medical Care programs are designed with a month-to-month payment model, allowing our clients to cancel at any time and for any reason. However, as detailed in the Membership Service Agreement (Agreement) point #11, a thirty-day cancellation notice is required to terminate the Agreement.

    All active members listed in the original Agreement or added to your account during the Agreement's active period will be able to utilize all Personal MD services until the final date the contract is active. After the Agreement is terminated, Personal MD and its providers will no longer provide medical services of any kind for any member listed on the contract unless the member converts to a Specialty Service contract or initiates a new Membership Service Agreement and pays the appropriate fees.

    By submitting this form, members acknowledge Personal MD maintains the right to change our membership programs, services provided, and cost of services without notifying you or any contracted member. If you initiate a new contract with Personal MD, you will be subject to the current cost structure and the services included.


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