Vitality Hormones & IV Bar Membership Agreement Form
  • Vitality Membership Agreement

    Complete this form to enroll in a membership program and acknowledge all terms, consents, and legal agreements.
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  • Format: (000) 000-0000.
  • Membership Subscription Agreement

    Membership Subscription Agreement Whereas Member desires to become a Member of Vitality and cannot become a Member without agreeing to the rules and regulations set forth below and abiding by the terms of this Agreement; Whereas, Vitality offers a menu of certain treatments and procedures as a monthly subscription, the terms of which are more fully described herein and in the addendum attached as Addendum A (prices subject to change without effecting the enforceability of this agreement, but changes to pricing and available services will be available upon request); Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, more fully described in Addendum B, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: All recitals set forth above are hereby incorporated into this agreement and enforceable by both parties. Vitality Services and Treatments subject to this Agreement: All fees and services are subject to change without written notice however will be available upon request. See attached Addendum AMembership Fees and CancellationMembership use and services must be paid for in advance. All fees and schedules are subject tochange without written notice. At the present time, membership fees are as follows:See attached Addendum BThe obligation to pay the monthly subscription fee is not dependent on the availability of all theVitality’s facilities, medications, vitamins or therapeutic modalities. Special engagements, repairs, andmaintenance of some facilities may make it necessary for the Vitality to from time to time, restrict use of,or close, portions of the facilities. Fees will not be reduced or suspended during the time when portions ofthe facilities are not available.
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  • Cancellation

    Monthly Renewing Members may cancel memberships by notifying Vitality personnel of his/herwish to cancel by email or text or in person by speaking with a supervisor, any time during business hours7 days prior to the date the subscription renews of the month to be cancelled. There are no refunds formembership fees, and Vitality will not prorate a cancelled membership.This Agreement may also be immediately terminated in the event that there is a breach of the termsof this Agreement by Member. This Agreement will also immediately terminate upon the death of theMember. Member’s obligations in this agreement will continue in the event Member fails to pay the fees1associated with this agreement, but Vitality will no longer be required to provide the services describedherein to Member until such time as the account is brought current and even then at the sole discretion ofVitality;By accepting this membership subscription agreement, Member agrees to provide a credit card tobe charged for fees associated with the treatments and procedures Member and Vitality professionalsjointly agree are appropriate for Member and to which Member consents (said consent memorializedherein).
  • Late Payment of Fees

    A late payment fee of $ 50 dollars will be charged on any payment past due. Membership fees mustbe paid on or before the renewal date of the month when the subscription was signed. Membership maybe cancelled, at the discretion of Vitality if fees are not timely paid.
  • Conduct

    Vitality is committed to the health, safety, and welfare of each of its members and staff and will nottolerate unreasonable, threatening, obscene, harassing, indecent, or illegal behavior. Vitality has the rightto judge behavior and respond accordingly. This right includes, but is not limited to, termination ofmembership of any member engaging in unacceptable behavior.
  • Miscellaneous

    A. This Agreement contains the entire agreement between the parties, and supersedes any priorwritten or oral agreements between them concerning the subject matter of this Agreement. Theprovisions of this may be waived, altered, amended or repealed, in whole or in part, only upon the priorwritten consent of all parties.B. Any dispute under this Agreement shall be required to be resolved by binding arbitration ofthe parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator andboth arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. Thearbitration shall be governed by the rules of the American Arbitration Association then in force and effect.C. Member has read, and fully agrees to the terms of this Agreement and understands andagrees that by signing this Agreement Member has given up considerable future legal rights. Member hassigned this Agreement freely, voluntarily, under no duress or threat of duress, without inducement, promiseor guarantee being communicated to him/her. Member certifies and warrants that he/she is ____ (i.e., ageof majority such as18) years of age or older and mentally competent to enter into this Agreement.
  • Legally Binding Agreement

    This Agreement forms a legally binding agreement between Member and Vitality and governs theMember's access and use of Vitality’s services (the "Membership Services") and physical facilities. ThisAgreement also covers Vitality’s provision of services (the "Membership Services") and physical facilities.
  • THIRD PARTY SERVICES:

    Certain Memberships Services may integrate, be integrated into, or be provided in connection withthird-party websites, services, content, and/or materials ("Third-Party Services"). Vitality does not controlany Third-Party Services. Vitality additionally makes no claim or representation regarding the third-partyservices and accepts no responsibility for the quality, content, nature, or reliability of Third-Party Servicesaccessible from Vitality’s websites, application, software or any other element of the MembershipServices. There is no implied affiliation, endorsement, or adoption by Vitality of these Third-Party Servicesand Vitality shall not be responsible for any content provided on or through these Third-Party Services. Youshould read the terms of use and legal agreements that apply to these Third-Party Services.
  • MEMBER CONSENTS

    In addition to matters set forth in Addendum C attached, Member agrees to the following:Member agrees to hold Vitality, its owners, affiliates, and representatives, harmless from anydamage, whether tangible or intangible, that may happen to Member while participating in theMembership Services.Member agrees that Vitality offers its membership program with no guarantee of results of anykind. Member agrees that any results that occur during their membership, whether positive or negative, are2the effects of Member's own personal choices.Member agrees and verifies that all of the information they have given Vitality and itsrepresentatives is accurate, up to date, and without the omission of any requested information.Member agrees and verifies that even if they have omitted any necessary personal information,whether knowingly or unknowingly, they will hold Vitality harmless against all liability for any damages thatmay occur to Member or others because of Member's actions or inactions.Member agrees to notify Vitality of any changes or upcoming changes concerning their personalinformation.
  • ASSUMPTION OF RISK:

    Member agrees and understands that his/her participation in the Membership Services may involverisks. These risks may lead to tangible or intangible harm, and Member agrees that these risks may resultnot only from their own actions but also from the actions of others. With the knowledge andunderstanding of these risks, Member chooses, of their own will and volition, to continue participating inthe Membership Services.
  • ENTIRE AGREEMENT:

    This Agreement constitutes the entire understanding between the Member and the Organizationwith respect to any and all use of the activities and facilities. This Agreement supersedes and replaces allprior or contemporaneous agreements or understandings, written or oral, regarding the Parties'relationship.
  • CHOICE OF LAW

    This agreement shall be interpreted according to the laws of the State of Texas.
  • Addendum A

    Programs currently approved for monthly subscription services include:-IV Vitamin Infusion Membership (3 programs to choose from)-Vitamin Injection Program-Rewards Program-Home Testosterone Injection Program-Long Haulers Hormone Club-All Inclusive Wellness Program-Emsculpt Maintenance Program
  • Addendum B

    Program PricingMembership ProgramsIV Vitamin Infusion Program (Non-transferable)*** Get a $ 99 Introductory IV of your Choice when you sign up for a membership program***Healthy & Happy – Includes (1) one IV infusion of your choice per month.10% off any IV add on’s.1 Free Vitamin Injection on your birthday!$ 125 dollars per monthFeeling Fabulous – Includes (2) two IV infusions of your choice per month.20% off any IV add on’s.1 Free Vitamin Injection on your birthday!1 Free mini IV for a friend every 12 months.$ 225 dollars per monthUltimate Wellness – Includes (3) three IV infusions of your choice per month.25% off any IV add on’s.1 Free Vitamin Injection on your birthday!31 Free mini IV for a friend every 6 months.$325 dollars per month.Vitamin Injection Program – $ 75.00 dollars per month1 Vitamin injection per week of your choice (10 injections to choose from)10% off any additional Vitamin injectionsRewards Program - $ 29.99 dollars per monthEnjoy 10% off any IV infusion, Vitamin Injection or supplements purchased during the month. Receive 1free vitamin injection per quarter.50% off 1 IV infusion every 6 months.Home Testosterone Injection Program - $ 150.00 dollars per monthIncludes a monthly follow up with a provider to manage and order refills of controlled substances.Long Haulers Hormone Club*** 90 day follow up required. All medications ordered in 90-day supply. 1 visit per 90 days for HRT followup. Only stable patients that have been with Vitality for 12 months are eligible. $ 199 per quarter onsubscription. Special Pricing only available on subscription program.***** All Inclusive Wellness Program**Individual Program Cost $ 1,000 per monthIncludes all Lab Testing at providers discretion per month.Weekly Injections of Testosterone or Testosterone Cream Substitute or home vialEstrogen or Progesterone replacement (If needed)Anastrozole or DIM supplement (if needed)1 IV of your choice per week1 IV add on of your choice1 Vitamin injection of your choice1 bottle of Supplements per month (Pure Encapsulations or Ortho-biotic)*Add your Spouse to the Wellness program for an additional $ 500 dollars a month** Emsculpt Maintenance Program**1 treatment area 1 x time per month to maintain results after 6 initial treatments = 150.00 2 treatment areas 2 x times per month to maintain results after 6 initial treatments = 250.00 3 treatment areas 3 x times per month to maintain results after 6 initial treatments = 350.00 Semaglutide Storage Program – $20.00 dollars each month - Store your vial of semaglutide at any of our 3 locations for a small fee
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      LASER HAIR MEMBERSHIP (FULL BODY)

      Each month - Full Body Treatment Area

      $99.00 for each month
        

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