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Consultation
Contract
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You must be 18 years or older to be
granted a consultation.
I
understand that by agreeing to this
contract , I am bound to pay for
informational consultation services only
and will so do and submit to the
jurisdiction of the State of California
where the information is disseminated. I
have faxed a true photo identification of
myself, a copy of my own credit card for
payment, and my signature.
I understand that discussion of medical
information does not create a
physician-patient relationship because
there is no material discussed
identifiable or pertinent to any one
individual and the data given and provided
is not intended for diagnosing any
condition or prescribing treatment as to a
specific person, but is informational in
nature only.
I
understand that any information given does
not suggest nor dictate an exclusive
course of treatment, diagnosis or
procedure to be followed and should be
construed only as informational and not to
exclude other methods of
practice.
I
understand that this block of time for
informational consultation is made by
WELLNESS MD on the WEB to
me at my request. I understand that any
personal information gathered at this site
is kept confidential and is not sold nor
given to any third parties.
Should a
discrepancy exist as to billable time of
the time block, the long-distance
carrier's statement will constitute the
time acceptable to both parties and the
subscriber irrevocably authorizes
WELLNESS MD on the WEB
access to the carrier records in regard to
the subscriber.
If I am not satisfied with the content of
the time block, I will address my concerns
in writing to WELLNESS MD on the
WEB, 1084 Cass Street, Suite A,
Monterey, Ca, 93940 All disputes will be
handled between WELLNESS MD on the
WEB and myself by
arbitration.
This
contract may only be enforced against all
persons and entities associated with
WELLNESS MD on the WEB in
the State of California, County of
Monterey, and under the internal laws of
the State of California. This
constitutes the complete contract between
myself and WELLNESS MD on the
WEB for telephone consultation
only.
I have
read and understand in its entirety this
contract between the WELLNESS MD
on the WEB and myself, the
subscriber. I attest that I am at
least 18 years of age.
By
clicking the " I Agree " link below, and
proceeding to the next step you agree to
the conditions of this Consultation
Contract.
[
I
Agree ]
...............................[
I
Don't
Agree
]
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