Anti-Aging Membership Agreement





This Anti-Aging Membership Agreement (“Agreement” ) specifies the terms and conditions under which you, the undersigned member ( “Patient” ), may participate in the Agreement. This agreement will become effective either on the date your myMDhome Affiliated Physician (“Affiliated Physician” ) commences the Program or the date of your signature of this Agreement, whichever is later than the (“Effective Date” ).
1. AFFILIATED PHYSICIAN. Patient understands and acknowledges that Affiliated Physicians participating in the membership may change from time to time certain Affiliated Physicians may no longer be able to accept new Patients due to Patient volume limits. If your designated Affiliated Physician is no longer available, myMDhome will notify you of such unavailability and will refund your annual fee if so desired, as explained in paragraph eight, below.
2. RELATIONSHIP BETWEEN AFFILIATED PHYSICIAN AND myMDhome. You understand and acknowledge that Affiliated Physicians are independent contractors and are not agents, servants or employees of myMDhome. myMDhome provides marketing services for the Affiliated Physician to enroll Patients in the myMDhome Anti-Aging Membership program. You further agree and understand that myMDhome does not provide, supervise or control the care that you receive from an Affiliated Physician. Rather, your care is furnished and directed solely by the Affiliated Physician who exercises his/her own medical judgment in his/her practice of medicine. myMDhome is not responsible for the judgment or conduct of any Affiliated Physician who renders services to you.
3. MEMBERSHIP BENEFITS. Affiliated Physician offers participating Patients the opportunity to receive certain Benefits as described below in exchange for a monthly fee in paragraph seven. Your Affiliated Physicians limited practice size also enables your Affiliated Physician to provide conveniences, such as same day or next day appointments that start on time, unhurried visits, availability via telemedicine at no additional charge to you. This Agreement describes the terms and conditions under which Affiliated Physician shall deliver such Benefits listed below to the undersigned Patient in exchange for the fees described below in paragraph seven:

  • Genetic testing with latest technology to identify patient’s risk, create patient’s health baseline to build preventative plan to monitor on our mobile app
  • Convenient appointment scheduling same or next day appointments
  • Access to your Doctor vie telemedicine: text, facetime, email??, cell or Skype
  • Access to Electronic Medical Records?
  • TBD % discount on the following procedures and programs:
    • minor skin excisions and biopsies (pathology lab fee is additional)
    • skin biopsy and wart/lesion abscess/cyst removal (cryotherapy)
    • nutrition and exercise plans
    • cosmetic services such as botulinum toxin injections, laser and light based therapies, dermabrasion, sclerotherapy and other skin improvement procedures.

4. MEDICAL CARE SERVICES EXCLUDED FROM THE ANNUAL MEMBERSHIP FEE. The annual fee specified herein covers only the Membership Benefits. Neither myMDhome nor your Affiliated Physician or his or her staff will seek reimbursement from any insurer or other third-party payer for the Benefits. Except for your benefits, 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 Affiliated Physician and his or her staff.
5. SERVICES NOT PART OF THE BENEFITS: Hospitalizations or hospital care, X-rays, emergency room visits, prenatal or obstetrical care, surgery, specialist office visits, cosmetic services, pediatric vaccinations are not part of the Benefits.
6. ANTI-AGING MEMBERSHIP IS NOT AN INSURANCE PLAN: Affiliated Physician is not an insurance company or plan, and does not promise unlimited care in exchange for Affiliated Physician fee as defined below. Affiliated Physician presumes that Patient has health insurance that provides health care coverage for services not covered by the Affiliated Physician fee. Participation in an Affiliated Physician Membership fee does not meet any individual health benefit plan mandate that may be required by federal law and the Patient is not entitled to health insurance protections for consumers under Title 10. (CO HB 17-1115). ??

  • Patients aged 0 to 25 years: TBD per person per month ?
  • Patients ages 26 +: TBD per person per month?
  • Family up to 2 adults and 2 children: TBD per family per month?

Affiliated Physician Membership fee reserves the right to adjust the Affiliated Physician Membership fee annually with advanced notice from Affiliated Physician to Patient. Participation in the Affiliated Physician Membership is personal to each individual accepted into the Affiliated Physician, and may not be assigned.
8. RENEWALS AND TERMINATION.The Annual Fee covers a period of one (1) year (the “Term”). Failure to pay the renewal Annual Fee prior to the anniversary of the Effective Date shall result in termination of your membership. For example, if the Effective Date is March 15th, 2018, then you must renew on or before March 14th, 2019. You or Affiliated Physician may terminate this Agreement at any time upon 30 days written notice. If you or Affiliated Physician terminate this Agreement for any reason prior to receiving your Membership Benefits, you will be entitled to a prorated refund of the Annual Fee. If you have received your Membership Benefits, you will not be eligible for a refund, and you will be responsible for the balance of the Annual Fee. Upon Affiliated Physicians receipt of the Agreement and the Annual Fee, the Affiliated Physician shall have the option, in its sole and absolute discretion, not to accept this Agreement and to return your payment to you (e.g., due to limitations in practice size). Unless otherwise terminated, this Agreement shall automatically renew for an additional one-year period upon the expiration of each Term.
9. EMAIL, COMMUNICATIONS AND PRIVACY. You should be aware that traditional e-mail ?? is not a secure medium for sending or receiving potentially sensitive personal health information. You also acknowledge and understand that e-mail in any form is not good medium for urgent or time sensitive communications. In the event a communication is time sensitive, you must communicate with your Affiliated Physician by telephone or in person. You acknowledge and understand that, at the discretion of your Affiliated Physician, your email may become part of your medical record.
10. ENTIRE AGREEMENT. The undersigned agrees to the terms of this Agreement, all of which are expressed herein. There are no promises or representations except as set forth herein.
11. NOTICES. Any communication required or permitted to be sent under this Agreement shall be in writing and sent via U.S. mail to the addresses set forth in this Agreement. Any change in address shall be communicated in accordance with the provisions of this section.
12. INVOICING. Affiliated Physician accepts most major credit cards for the annual payment. This agreement will be automatically renewed and the credit card you used to join this program will be charged per the billing cycle selected above. 13. GOVERNING LAW. This Agreement shall be governed by and construed in accordance with the laws of the State Of Florida without regard to Florida’s choice of law provisions.


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Signature Certificate
Document name: Anti-Aging Membership Agreement
lock iconUnique Document ID: 85f372060e4282ce81c0e7f547638c69f3358a7f
Timestamp Audit
July 8, 2019 9:02 am EDTAnti-Aging Membership Agreement Uploaded by Kevin Patrick Burke - IP