Vitality Membership Agreement
Complete this form to enroll in a membership program and acknowledge all terms, consents, and legal agreements.
Date of Agreement
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Month
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Full Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
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Burkina Faso
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Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Membership Program
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Please Select
IV Vitamin Infusion Program - Healthy & Happy
IV Vitamin Infusion Program - Feeling Fabulous
IV Vitamin Infusion Program - Ultimate Wellness
Vitamin Injection Program
Rewards Program
Home Testosterone Injection Program
Long Haulers Hormone Club
All Inclusive Wellness Program
Emsculpt Maintenance Program
Semaglutide Storage Program
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.
I have read and agree to the Membership Subscription Agreement, including fees, cancellation policy, and conduct expectations.
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I agree to the Membership Subscription Agreement
Date Signed
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Month
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Year
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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.
I understand and agree to the Member Consents and Assumption of Risk sections.
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I agree to the Member Consents and Assumption of Risk
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.
I agree with the entirety of this Vitality Hormones & IV Bar Membership Agreement.
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I agree with the entirety of this membership agreement.
CHOICE OF LAW
This agreement shall be interpreted according to the laws of the State of Texas.
I understand this agreement is governed by the laws of the State of Texas.
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I acknowledge the Choice of Law
Signature of Member
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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
Please review the details and select the membership you are interested in.
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VITAMIN INJECTION PROGRAM – $ 75.00 dollars each month - 1 Vitamin injection per week of your choice (10 injections to choose from) 10% off any additional Vitamin injections
HOME TESTOSTERONE INJECTION PROGRAM - $150.00 each month - Includes a monthly follow up with a provider to manage and order refills of controlled substances.
LONG HAULER MEMBERSHIP - $199.00 Every 3 Months - *** 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.***
SEMAGLUTIDE STORAGE PROGRAM – $ 20.00 dollars each month - Store your vial of semaglutide at any of our 3 locations for a small fee
REWARDS PROGRAM - $29.99 each month - Enjoy 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.
ALL INCLUSIVE WELLNESS PROGRAM - $1,000.00 each month - 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)
ALL INCLUSIVE WELLNESS PROGRAM WITH SPOUSE - $1,500.00 each month - All benefits of Individual Program Cost with additional individual receiving the same benefits
EMSCULPT MAINTENANCE PROGRAM (1 AREA) - $150.00 each month - 1 treatment area 1 x time per month to maintain results after 6 initial treatments = 150.00
EMSCULPT MAINTENANCE PROGRAM (2 AREAS) - $250.00 each month - 1 treatment area 1 x time per month to maintain results after 6 initial treatments = 250.00
EMSCULPT MAINTENANCE PROGRAM (3 AREAS) - $350.00 each month - 3 treatment areas 3 x times per month to maintain results after 6 initial treatments = 350.00
HAPPY & HEALTHY IV MEMBERSHIP - $125.00 each month - *** Get a $ 99 Introductory IV of your Choice when you sign up for a membership program*** Includes (1) one IV infusions of your choice per month.10% off any IV add on’s.1 Free Vitamin Injection on your birthday! $125 dollars per month
FEELING FABULOUS IV MEMBERSHIP - $225.00 - *** Get a $ 99 Introductory IV of your Choice when you sign up for a membership program*** 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 month
ULTIMATE WELLNESS IV MEMBERSHIP - $325.00 - *** Get a $ 99 Introductory IV of your Choice when you sign up for a membership program***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.
LASER HAIR MEMBERSHIP (SMALL/MEDIUM) - $20.00 each month - Small/ Medium Treatment Area
LASER HAIR MEMBERSHIP (LARGE) - $50.00 each month - Large Treatment Area
LASER HAIR MEMBERSHIP (FULL BODY) - $99.00 each month - Full Body Treatment Area
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LASER HAIR MEMBERSHIP (FULL BODY)
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