The following outlines the terms and conditions for the Functional Medicine Program ("FM Program") between the undersigned, (“Patient”) and Sparks Family Medicine, Ltd. (“SFM”). The Patient should review the information in this Agreement, including their rights and responsibilities, and retain a copy of this Agreement for future reference. Questions should be directed to the designated Program contact at SFM at 702-722-2200 or contact Contact@sparksfamilymedicine.com.
1. FM Program Description
1.1. The FM Program provides access to integrative and functional medicine (“I&FM”) not covered by health insurance.
1.2. The FM Program is not insurance, a medical discount plan, or a membership plan.
1.3. There may be additional costs for I&FM, with additional fees due at the time of service.
1.4. SFM may offer products and services that are not included in the FM Program.
1.5. The I&FM components of FM Program are subject to change without notice and may be removed at any time.
1.6. The FM Program uses a platform for I&FM resources (“the Platform”) that is maintained by a third party, Functional Medicine Energy Center, (“FMEC”) and requires a monthly fee. SFM is a beneficiary of the FMEC monthly fee.
1.7. The FM Program requires Patient to register and maintain access to the Platform, including completion of Attachment A to this Agreement.
1.8. All FM Program payments are nonrefundable.
2. Patient Responsibilities
2.1. Patient is responsible for accessing I&FM provided by the FM Program upon execution of this Agreement.
2.2. Patient will identify to SFM that they have an active FM Program Agreement on file with SFM when accessing products and services.
2.3. Patient will execute Attachment A and maintain access to the Platform.
2.4. Patient will make all Platform payments to remain in good standing.
2.5. Patient will provide a credit card or bank account information for recurring Platform payments.
2.6. Patient will notify SFM of any changes to residency, insurance, or payment information.
2.7. Failure to keep the Platform in good standing can result in Termination of the FM Program Agreement in accordance with Section 4 below.
2.8. Patient agrees not to disclose, discuss, or disseminate the specifics of SFM’s FM Program, including any trade secret, technical information, form, or agreement.
3. Changes
3.1. FM Program products, services, and their cost may be changed at any time.
3.2. The price of the Platform payments may be changed with 60-day notice, with notice provided on-line at www.SparksFamilyMedicine.com and posted at SFM. SFM will email Patient notice of payment change to the email on file.
4. Termination
4.1. The FM Program may be terminated by Patient with notification to SFM by email at contact@sparksfamilymedicine.com at least five days PRIOR to when the next Platform payment is due to avoid additional Platform charges.
4.2. The FM Program may be terminated by SFM if Patient fails to keep their SFM account current or fails to maintain active Platform access.
4.3. A processing fee may apply for Patient to re-enter into a Program Agreement within six months of terminating a FM Program Agreement.
4.4. The FM Program may be terminated at any time, with notice of termination posted in office, at sparksfamilymedicine.com and emailed to active FM Program patients.
5. Miscellaneous
5.1. The laws of the State of Nevada shall govern the validity of this Agreement, the construction of its terms and the interpretation of the rights and duties of the parties hereto.
5.2. Patient agrees to indemnify and hold harmless SFM from and against, but not limited to, all losses, claims, damages, errors, expenses or liabilities arising from the administration of the FM Program.
5.3. Parties agree that, except for credit card/bank charge/charge back disputes, the sole remedy for any controversies arising out of the terms of this Agreement or its interpretation for either party shall be Termination of the Agreement in accordance with Section 4.
5.4. This Agreement constitutes the entire agreement between the parties pertaining to the FM Program between Patient and SFM and supersedes all prior or contemporaneous agreements, understandings, or negotiations of the parties, but may be amended by SFM per notice included in 3.2.
5.5. Should any provision of this Agreement be held invalid, unenforceable, or unconstitutional by any governmental body or court of competent jurisdiction, such holding shall not diminish the validity or enforceability of any other provision hereof.
5.6. Patient may not assign the Agreement to another party.
5.7. The Agreement is assignable by SFM only to a successor professional corporation.
5.8. Patient authorizes SFM and its third-party administrators and vendors to send email or text, which may include the minimum necessary protected health information related to Patient status in the IW Program and payments, such as receipts, payment reminders, and other communications that may include the minimum essential personal health information, such as patient name, appointments, and payments received or due.
6. Enrollment Information
6.1. The FM Program is $995 for the Holistic Clinical Review, which includes an extended orientation visit, ATP session, ART session, and follow-up discussion. This payment is payable in advance of the first visit. As these services are not conventional services, no charges will be billed to insurance. No superbill will be provided to Patient. This payment is in addition to the Platform fee, (see Attachment A).
6.2. Patient’s credit card or bank on file will be charged for the initial orientation up to three days before the Patient’s initially scheduled orientation.
6.3. FM Program payments are nonrefundable.