HUMAN SYNC MEDICAL PATIENT AGREEMENT
Effective Date: August 1, 2024
This Patient Agreement (“Agreement”) governs your use of the health optimization and wellness services (“Services”) provided by Human Sync. Please read this Agreement carefully before using Human Sync’s Services.
By signing this Agreement or by acknowledging electronically on Human Sync’s website, you (“Patient”) agree to the terms of this Agreement, including the Telehealth Services Consent outlined below.
- Updates to the Agreement
Human Sync may revise this Agreement at any time. If changes are made, Human Sync will update the “Effective Date” and provide a notice. If you continue using the Services after the updated date, you agree to the new terms.
- Financial Responsibility
You agree to pay all applicable charges for the Services as outlined in the payment agreement. You authorize Human Sync and its agents to charge your chosen payment method. All charges are due at the time Services are first rendered. Human Sync reserves the right to correct any billing errors.
- Permission to Treat
By accepting this Agreement, you give Human Sync permission to provide care. You may withdraw this consent at any time by discontinuing use of the Services. Patient data, including Protected Health Information (PHI), may be stored and used in accordance with Human Sync’s Notice of Privacy Practices.
- Termination of Services
You may terminate use of the Services at any time by ceasing to use them. Human Sync reserves the right to terminate your use for causes such as non-payment or violation of the terms herein. No refunds will be issued if Services are terminated.
- Consent to Electronic Communications
You agree that Human Sync may communicate with you electronically. Communications may include disclosures, notices, or other information related to your care and may contain PHI. Human Sync is not liable for unauthorized access to PHI when using electronic
communication methods. To opt out of communications, email
Erik@HumanSyncHealth.com.
- Disclaimers
Human Sync’s Services are not intended for emergency or life-threatening conditions. In such cases, call 911. Human Sync is not liable for any damages resulting from use of or inability to use the Services, except in cases of negligence or willful misconduct.
- Limitation of Liability
To the maximum extent permitted by law, Human Sync is not liable for any consequential, exemplary, incidental, or punitive damages arising from your use of the Services, even if advised of the possibility of such damages.
- Telehealth Services Consent
Human Sync may provide Telehealth Services, including consultations through virtual technology when the provider and Patient are not in the same physical location. This may include real-time or asynchronous communications (e.g., video calls, text, data sharing). You acknowledge the risks of telehealth, including the potential for unauthorized PHI disclosure.
You may withdraw consent to Telehealth Services by discontinuing their use at any time. 9. General Provisions
This Agreement constitutes the entire understanding regarding your use of Human Sync’s Services and supersedes all prior agreements. Human Sync may change, suspend, or discontinue any part of the Services at its discretion. Terms that by their nature should survive termination will remain in effect.
If you have any questions, please contact us at Erik@HumanSyncHealth.com