Membership Agreement
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Thank you for joining our primary care practice! We look forward to partnering with you in your health care. Our goal is to provide a higher level of personalized care for our patients.
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Expanded Healthcare Benefits:
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Term/Renewal/Administrative Fee:
ProctorMD charges a yearly Administrative Fee. This fee is not for medical care and the reason we continue to bill your insurance as usual. Your share of cost for covered services, which may include your deductible and co-pay, is also collected. The Administrative fee covers the enhanced services/benefits listed above and allows us to keep our patient panel limited to a maximum of 400-500 patients.
The annual Administrative Fee covers a period of one year (12 months) and is due at the time of enrollment. It will automatically be renewed each year as a charge on the Member’s credit card on file with the practice (or in whatever manner your initial fee was paid). A Member DOES have the ability to terminate or cancel membership at any time. While we value your presence in our practice, you are under no obligation to continue receiving services and you may terminate this Agreement, in writing, upon thirty (30) days’ written notice to the Practice. We will prorate and return any portion of the yearly fee that may still remain for the term.
If you choose to discontinue your Membership but later wish to re-enroll, Practice reserves the right to decline re-enrollment or require you pay a re-enrollment fee that is equivalent to the months absent while you were not enrolled (not to exceed 12-months).
Practice also reserves the right to cancel any Membership for cause including: non-payment; threats to staff, physicians, or other patients; disruptive behavior. If Practice does elect to cancel Membership Agreement, we will provide Member with 30-days’ written notice and cover you for any urgently needed care or medication refills for that 30-days.
We prefer the Administrative Fee be paid on an Annual (once-yearly) basis, but other payment plans are an option. Please inquire about biannual, quarterly, or monthly payment options.
Thank you for joining our practice! We truly value your presence and look forward to your being a part of our medical family here at ProctorMD.
ProctorMD charges a yearly Administrative Fee. This fee is not for medical care and the reason we continue to bill your insurance as usual. Your share of cost for covered services, which may include your deductible and co-pay, is also collected. The Administrative fee covers the enhanced services/benefits listed above and allows us to keep our patient panel limited to a maximum of 400-500 patients.
The annual Administrative Fee covers a period of one year (12 months) and is due at the time of enrollment. It will automatically be renewed each year as a charge on the Member’s credit card on file with the practice (or in whatever manner your initial fee was paid). A Member DOES have the ability to terminate or cancel membership at any time. While we value your presence in our practice, you are under no obligation to continue receiving services and you may terminate this Agreement, in writing, upon thirty (30) days’ written notice to the Practice. We will prorate and return any portion of the yearly fee that may still remain for the term.
If you choose to discontinue your Membership but later wish to re-enroll, Practice reserves the right to decline re-enrollment or require you pay a re-enrollment fee that is equivalent to the months absent while you were not enrolled (not to exceed 12-months).
Practice also reserves the right to cancel any Membership for cause including: non-payment; threats to staff, physicians, or other patients; disruptive behavior. If Practice does elect to cancel Membership Agreement, we will provide Member with 30-days’ written notice and cover you for any urgently needed care or medication refills for that 30-days.
We prefer the Administrative Fee be paid on an Annual (once-yearly) basis, but other payment plans are an option. Please inquire about biannual, quarterly, or monthly payment options.
Thank you for joining our practice! We truly value your presence and look forward to your being a part of our medical family here at ProctorMD.
PMD Membership Agreement
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