This Patient Agreement (this “Agreement”) governs your use of the medical services (“Medical Services”) provided by the medical practices affiliated with Aura USA, Inc. (“Aura”), including without limitation Adrian Blackwell, M.D. ( collectively, “Aura Medical,” “we” or “us”). Please read this Agreement carefully before receiving medical services from Aura Medical.
By signing this Agreement as either the patient or patient’s legal representative, guardian, conservator, or custodian of a minor child (under 18 years of age, except as otherwise permitted by the laws of the state in which the patient is located) or other person lacking the ability to consent (collectively, “you”), you acknowledge you have read, accepted, and become legally bound to the terms and conditions set forth below, including in the Telehealth Services Consent contained herein. The terms “You” or “you” shall also mean the patient or recipient of health care services. We reference the Aura Medical website as the “Site” and the Aura Medical app as the “App” in this Agreement.
DO NOT USE THE MEDICAL SERVICES, INCLUDING THE TELEHEALTH SERVICES, FOR EMERGENCY OR LIFE-THREATENING MEDICAL MATTERS. FOR ALL LIFE THREATENING MATTERS, IMMEDIATELY CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM.
1. Updates to the Agreement
Aura Medical may, in its sole discretion, without prior notice to you, revise this Agreement at any time. Should this Agreement change materially, Aura Medical will update the “Updated” date noted above and post a notice regarding the updated Agreement. If you do not agree with the proposed changes, you should discontinue your use of the Medical Services before the effective date of the change. If you continue using the Medical Services after the Updated date, you will be bound by the updated Agreement.
2. Your Financial Responsibility; Assignment of Benefits
You agree to pay Aura Medical all applicable charges and payment responsibility at the prices then in effect for the Medical Services provided to you or another person on whose behalf you are accepting this Agreement (such as your children or other family members) (each a “Covered Family Member”), and in accordance with the financial policy set forth in Section 2.1 of this Agreement. You will be charged for the Medical Services provided to you or your Covered Family Member by an Aura Medical practitioner. You authorize Aura Medical and its agents to charge your chosen payment method (your “Payment Method”) for the Medical Services provided to you or your Covered Family Member. If your Payment Method is invalid at the time payment is due, you agree to pay all amounts due upon demand. The third-party services provider who manages your Payment Method may impose terms and conditions on you, which are independent of this Agreement, and you agree to comply with all of those terms. Aura Medical may accumulate charges that you have incurred for the Medical Services and submit them as one or more aggregate charges during or at the end of each billing cycle. Aura Medical reserves the right to correct any billing errors or mistakes even if payment has already been requested or received.
If you provide information about your health insurance or health plan, that will be deemed your authorization for us to submit claims for covered Medical Services to your health insurer or health plan. You hereby assign or otherwise authorize payment of medical benefits to Aura Medical for the Medical Services provided to you or your Covered Family Member. You authorize the release of any medical or other information necessary to process any claims for the Medical Services provided. You further understand and accept your financial responsibility for any portion of the bill not covered by your health insurer or health plan. SUBMISSION OF CHARGES DOES NOT WAIVE OUR RIGHT TO SEEK PAYMENT DIRECTLY FROM YOU.
2.1. Financial Policy
You agree that all payments are due at the time of service.
Payments may be made via Stripe in the App.
3. Permission to Treat
You hereby give permission to Aura Medical to medically care for your Covered Family Member or you. You may withdraw this consent at any time by no longer seeking Medical Services from Aura Medical. You understand that if you refuse recommended medical care, you will not hold Aura Medical, any of its staff or physicians, or any other practitioner (each a “Aura Medical Clinician”) responsible for any consequences of your refusal of care.
You understand and agree that as part of providing Medical Services to your Covered Family Member or you, your protected health information (“PHI”), including test results, may be released to an online personal health record and via communication with Aura Medical Clinicians electronically. You further understand and agree that in providing Medical Services to you, your PHI, payment information, and other information may be shared with a laboratory services provider.
4. No Show Policy
You agree to provide notice at least twenty-four (24) hours prior to your appointment if you will be unable to attend. If you miss your appointment without twenty-four (24) hours’ advance notice, the fee paid to Aura Medical will not be refunded. Missing three or more appointments without advanced notice in a twenty four (24) month period can be cause for dismissal from Aura Medical for you or your Covered Family Member. Failure to keep an initial appointment to establish care is also cause for dismissal from Aura Medical.
5. Service Termination
You may terminate your use of the Medical Services at any time by not using the Medical Services anymore. We may terminate your use of the Medical Services at any time in our reasonable discretion, for causes including but not limited illegal conduct such as falsifying information, abusive and threatening behavior, and continued refusal to pay for our services. In the event that we terminate your use of the Medical Services, we will send notice to you at the mail or email address you provided to us or by otherwise contacting you.
6. Consent to Electronic Communications
You agree that Aura Medical may send the following to you by email or by posting them on our Site or App: legal disclosures; this Agreement, including the Telehealth Services Consent; future changes to any of the above; and other notices, policies, communications or disclosures and information related to the Medical Services.
By signing this Agreement, you agree that Aura Medical may contact you via (secure) messaging, email, phone, text, or mail regarding the Medical Services, including electronic communications from Aura Medical pertaining to your care and your health, which may include PHI. You understand that communication via email, text messages, and other electronic means selected by Aura Medical may not be secure and could be viewed by unintended persons, and you or on behalf of your Covered Family Member agree to exchange of communications, to and from Aura Medical via these electronic means. You agree to update your contact information to ensure accuracy.
If you later decide that you do not want to receive certain future communications electronically, please send an email to email@example.com or a letter to Aura Medical, 228 Park Avenue South PMB 75218, New York, New York 10003-1502 US. You may also opt out of certain electronic communications through your account or by following the unsubscribe instructions in any communication you receive from Aura Medical. Your withdrawal of consent will be effective within a reasonable time after we receive your withdrawal notice described above.
Aura Medical will need to send you certain communications electronically regarding the Medical Services. You will not be able to opt out of those communications – e.g., communications regarding updates to this Agreement or information about billing. Your withdrawal of consent will not affect the legal validity or enforceability of the Agreement provided to and accepted by, you.
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, EXCEPT IN CASE OF NEGLIGENCE OR WILLFUL MISCONDUCT, WE AND OUR AFFILIATES, AURA MEDICAL, PARTNER PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS WILL NOT BE RESPONSIBLE FOR ANY LOSS OR DAMAGE, INCLUDING PERSONAL INJURY OR DEATH, RESULTING FROM ANYONE’S USE OF OR INABILITY TO USE THE MEDICAL SERVICES.
The Medical Services are intended for use only within the United States and its territories. We make no representation that the Medical Services are appropriate, or are available for use outside the U.S. or outside of the states in which Aura Medical operates medical practices. Those who choose to access and use our Medical Services from outside the U.S. do so on their own initiative, at their own risk, and are responsible for compliance with applicable laws.
8. Limitation of Liability
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, IN NO EVENT WILL WE AND OUR AFFILIATES, PARTNER PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS BE LIABLE FOR ANY CONSEQUENTIAL, EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING WITHOUT LIMITATION THOSE RELATING TO LOST PROFITS OR THE COST OF SUBSTITUTE PRODUCTS OR SERVICES ARISING OUT OF OR IN CONNECTION WITH THE MEDICAL SERVICES OR FROM THE USE OF OR INABILITY TO USE THE MEDICAL SERVICES, WHETHER BASED ON CONTRACT, WARRANTY, PRODUCT LIABILITY, TORT OR OTHER LEGAL THEORY AND EVEN IF WE HAVE BEEN INFORMED OF THE POSSIBILITY OF SUCH DAMAGES. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SO THE ABOVE EXCLUSION MAY NOT APPLY TO YOU.
9. Telehealth Services Consent
Aura Medical may directly provide Medical Services to you or your Covered Family Member using virtual technology when the Aura Medical Clinician and patient are not in the same physical location, and/or deliver health care services virtually, including by a medical provider or via digital or automated tools, including without limitation tools for medical or health-related diagnosis or treatment (the “Telehealth Services”). Telehealth may be used for diagnosis, treatment, care, follow-up and/or patient education, and may include, without limitation, the following: electronic transmission of patient medical records, medical images, and/or other patient data or information; synchronous (i.e., “real time”) and asynchronous (i.e., non-”real time”) interactions via audio, video, text, and/or data or other electronic communications; automated, electronic or digital tools or services for diagnosis, care, treatment and/or communication pertaining to healthcare or medical matters; and output, transmission or exchange of data from medical devices, sound and video files. You understand that virtual encounters required to receive Telehealth Services via phone, email, video, or otherwise, could involve certain limitations and risk, such as unauthorized disclosure of PHI, and you hereby consent to the use of automated tools for diagnosis, care, treatment or communication pertaining to healthcare matters. You also acknowledge that such virtual encounters may involve care by a variety of types of Aura Medical Clinicians, including physicians, registered nurses, nurse practitioners, physician assistants, and other support or medical personnel in accordance with applicable laws and regulations.
Unless you object, you give permission to Aura Medical to record and process your personal details and medical data generated during the provision of Telehealth Services. You may withdraw these permissions at any time by no longer seeking Telehealth Services from Aura Medical.
10. Use of the Telehealth Services
You agree to the following terms with respect to use of the Telehealth Services:
• You understand that there may be possible risks and limitations of the Telehealth Services, including that it may be possible that your condition cannot be treated via the Telehealth Services, or that information transmitted through the Site or App may not be sufficient or of too poor of image quality, or there may be insufficient information or data to allow for appropriate medical decision making. Accordingly, you may be required to seek additional in-person medical care, alternative healthcare or emergency services. If your health or medical problem or condition persists after use of the Telehealth Services, you will immediately contact your medical services provider and seek appropriate additional in-person medical care or emergency care, as appropriate.
• You understand that in rare circumstances, security protocols could fail, causing a breach of privacy that allows unauthorized persons access to your PHI.
• You agree NOT to use the Site or App using an unsecured public Wi-Fi or other unsecure electronic communication.
• You agree NOT to record any audio or visual communication transmitted via the Site or App, including Telehealth Services, without the express consent of all communicating parties.
• You understand that you are responsible for providing accurate information through the Site and App, including demographics and location information, medical histories, medication use, current adverse conditions, financial information, and keeping all such information current.
• You agree to follow all recommendations, protocols and other instructions you receive concerning the use of the Site, the App, and from Aura Medical concerning the Telehealth Services.
11. Dispute Resolution
Agreement to Arbitrate
Arbitration location and procedure
12. General Provisions
This Agreement, including the Consent to Treatment via Telehealth, makes up the entire agreement relating to your use of the Medical Services, and supersedes all prior agreements relating to the subject matter hereof. We may change, suspend, or discontinue any of the Medical Services at any time. We will try to give you prior notice of any material changes to the Medical Services. We will not be liable to you or to any third party for any modification, suspension or discontinuance of the Medical Services.
This Agreement does not confer any third-party beneficiary rights. You may not transfer any of your rights or obligations under this Agreement to anyone else without our consent. Aura Medical may assign its rights in connection with a merger, acquisition, or sale of assets, or by operation of law or otherwise.
Even after termination, this Agreement will remain in effect such that all terms that by their nature may survive termination will survive such termination.
If you have any questions about this Agreement, please contact firstname.lastname@example.org