Membership Agreement
Personal M.D. Family Healthcare, P.A. (Personal MD or Clinic) is a Direct Primary Care practice as defined by Texas Occupations Code 162 Subchapter F. The captions in this agreement are only for convenience and have no legal meaning.
Notice: This Member Service Agreement does not constitute health insurance and is not a medical plan that provides health insurance coverage for the purposes of the Patient Protection and Affordable Care Act.
1. Legal Significance. I acknowledge that this agreement is a legal document that gives the parties certain rights and responsibilities. I have been given a reasonable time to seek legal advice regarding this agreement and am satisfied with its terms and conditions.
2 . Governing Law and Venue. This agreement shall be governed and construed under the laws of the State of Texas. The parties agree that the Texas state and federal courts in Collin County shall be the exclusive courts of jurisdiction and venue for any legal action, particular proceeding, or other proceeding that may be brought, or arise out of, in connection with, or because of this agreement. The parties waive any venue rights in any other courts they might otherwise have.
3. Entire agreement. This agreement contains the entire agreement between the parties and replaces any earlier understandings and agreements, whether written or oral.
4. Change of Law. If any relevant law, regulation, or rule changes at a federal, state, or local level affect the terms of this agreement, the parties agree to amend this agreement to comply with the law.
5. Severability. Suppose a court of competent jurisdiction considers any part of this agreement legally invalid or unenforceable. In that case, that part of this agreement will be amended to the extent necessary to be enforceable, and the remainder of this agreement will be in force as originally written.
6. Services. In this agreement, "Primary Medical Care" and "Services" are defined by Texas Occupations Code 162.251 (5). By signing this agreement, you acknowledge that you seek primary medical care and do not need urgent or emergency healthcare services.
7. Member. In this agreement, "Member" means the person(s) listed on the Membership Billing Form or the Add/Remove a Member form designed by Personal MD.
8. Acknowledgment. The guarantor of the agreement acknowledges that they have voluntarily entered into this agreement under which they will be responsible for paying the Direct Fee and any miscellaneous charges for supplies or services not covered by Personal MD, including, but not limited to, medications, supplements, Platelet Rich Plasma, and laboratory services.
9. Term. This agreement's initial term begins when both parties sign the Medical Service Agreement and Personal MD accepts an initial deposit.
10. Renewal. This agreement will automatically renew on the first or fifteenth of the month as designated on the Membership Billing Form below.
11. Termination. Notwithstanding anything in this agreement, either party has the right to cancel this agreement at any time. To terminate this agreement, either party must provide a thirty-day notice. For the Member to terminate the agreement, the Personal MD Cancellation Form, found at personalmd.net, must be filled out and submitted to initiate the termination process. The date of submission will act as the first day of notice. Terminating this agreement will also terminate the relationship between you and the Clinic with at least thirty days from submission to give adequate notice to the parties, provide a reasonable time to find a new physician, and avoid patient abbadonment. The Clinic will comply with all applicable laws, rules, and regulations concerning ending the physician-patient relationship. Upon request, the Clinic will transfer medical records to the new physician upon signed authorization.
11. Direct Fee. In exchange for Services, you agree to pay Personal MD a Registration Fee and a Direct Fee outlined in the Membership Billing Form. The Direct Fee will be prorated at the time of registration. Direct Fee payments will occur each month thereafter until either party terminates the membership contract, as noted in #11 above. I understand the Direct Fee will continue to be paid monthly while your contract is active and for thirty days from the date of submitting the Cancelation Form. I also acknowledge that if the Direct Fee is adjusted, the Guarantor designated on the Membership Billing Form will be notified in writing at least sixty days before any changes can be made to the Direct Fee, giving Member (s) time to Terminate this Agreement if desired.
12. Construction. If an ambiguity or a question of intent or interpretation arises, this Medical Service Agreement shall be construed without regard to any presumption or rule requiring construction or interpretation against the party who drafted the contract.
13. Served. All written notices are deemed served if sent by U.S. mail to the party's address written on the original "Membership Billing Form" or the "Billing Update/Change."
14. Confidentiality. Member understands this agreement is not considered part of a medical record, and the terms and conditions of this agreement will not be transmitted to any other party if copies of all or part of your medical record are transmitted.
15. Original Copy. A photocopy or scanned copy of this Medical Service Agreement will be considered an original.
16. Certification. By agreeing to the Membership Service Agreement, you certify that you have read this entire agreement, been allowed to ask questions and receive answers about all its provisions, and have sought legal advice. Personal MD will keep a digital copy of this agreement in the primary Member's chart and send you a digital copy by email to the preferred email listed above at no charge. The primary Member can request a printed copy of this agreement, but will be required to pay administrative charges prior to receiving a printed copy.