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PATIENT AGREEMENT
This Patient agreement (the "Agreement") specifies the terms and conditions
under which you, the undersigned patient ("Patient"), may participate in the
Program ("Program") offered by Bruce Aronwald, D.O. and/or Anthony J. Cioce,
D.O. ("your physician"). This Agreement will become effective as the
date set forth at the end of this Agreement (the "Effective Date").
1. Program. The Program's annual fee encompasses the following
services ("Services"):
- Annual Preventive Care Physical Examination
- Comprehensive Wellness Plan
In addition to the Services encompassed by the annual fee,
the following benefits are provided at no charge:
- Same or Next Day Appointments
- Unhurried Visits
- No Waiting, On time Appointments
- Physician Availability (24x7)
- Dedicated Support Personnel
- E-mail/Fax Access
- Prescription Facilitation
- Enhanced Coordination of Necessary Referrals
- Travel Medical Services
- Private Reception Area
2. Annual Patient Fee. Each Patient 21 or older will pay an annual
fee of $1800 ("Annual Fee"). Each Patient under the age of 21 will
pay an annual fee of $900.
3. Renewals and Termination. The Annual Fee covers a period of one
(1) year. Failure to pay the renewal Annual Fee prior to the anniversary of
the Effective Date shall result in termination of your participation in the Program.
(For example, if the Effective Date is May 15th, 2003 then you must renew on
or before May 14th, 2004). You or your physician may terminate this Agreement
at any time upon 30-days prior written notice. If you or your physician
terminate this Agreement for any reason, you will be entitled to a prorated refund of any
unused portion of the Annual Fee. Such prorated refund will be based on the
number of days you have participated in the Program, and whether you received your Annual
Preventive Care Physical Examination. Upon your physician.s receipt of this
Agreement and the Annual Fee, your physician shall have the option, in his sole and
absolute discretion, not to accept this Agreement and to return your payment to you (e.g.,
due to limitations on the number of patients).
4. Medical Care Services Excluded from Annual Fee. The Annual Fee
specified herein covers only the defined "Services". Except for your
Annual Preventive Care Physical Examinations and Comprehensive Wellness Plan, you and/or
your insurer, as the case may be, will be financially responsible for paying for all
healthcare and medical care services received by you from your physician and his staff.
Your physician will be you and/or your insurer, as the case may be, for those
medical or health care services provided to you.
5. Co-Payments. The Annual Fee does not affect the co-payments,
co-insurance, or deductibles that you are required to pay pursuant to the terms of your
insurance coverage. You will be financially responsible for any co-payments,
co-insurance of deductible amounts required by your insurer.
6. E-mail Communication; Privacy. If you wish to send e-mail
communications to and receive e-mail responses from your physician and/or his employees,
agents, and representatives, you should be aware that e-mail is not a secure medium for
sending or receiving potentially sensitive personal health information.
Although your physician will take steps to keep your communications confidential and
secure, the confidentiality of e-mail communications cannot be assured or
guaranteed. You also acknowledge and understand that e-mail is not a good
medium for urgent or time-sensitive, you must communicate with your physician by telephone
or in person. You acknowledge and understand that, at the discretion or your
physician, your e-mail may become part of your permanent medical record.
7. Entire Agreement. Each of the undersigned agrees to the terms
of this Agreement, all of which are expressed herein. There are no promises of
representations except as set forth herein.
8. Notices. Any communication required or permitted to be sent
under this Agreement shall be in writing and sent via facsimile or via certified mail,
return receipt requested, to the addresses set forth below. Any change in
address shall be communicated in accordance with the provisions of this section.
9. Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of New Jersey.
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