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Take CHARGE of Your Health, LLC agreement with CLIENT
This Client Agreement (“Agreement”) is effective as of the date of the last signature (the “Effective Date”), by and between Take CHARGE of Your Health, LLC (“Take CHARGE” or “Company”), a Michigan LLC and Client. Company and Client shall be collectively referred to as the “Parties” and individually referred to as the “Party.”

DISCLOSURE:

Take CHARGE provides health education, advocacy and coaching services (“Health Care Coaching”). Our aim is to provide excellent interprofessional and individualized health education which you can use to maintain and hopefully improve your health, working with your healthcare providers.
Take CHARGE is NOT providing medical care (e.g. prescriptions, physical examinations, or laboratory tests). You should NOT seek medical care from Take CHARGE.

You should NOT try to replace, or substitute Take CHARGE for your existing advice and care from your healthcare provider. Take CHARGE strives to work in concert with your healthcare provider.

Take CHARGE will provide additional education and information about the benefits of seeking additional medical and professional advice and care if needed, but these are only recommendations, and also do not guarantee or promise a different or better outcome.

WHAT Take CHARGE of Your HEALTH AGREES TO DO:
Take CHARGE will conduct an initial free consultation/evaluation to determine if you might benefit from the information and advice being offered by Take CHARGE. If you might benefit from the information and advice, Take CHARGE will provide you options for formal paid consultations which you can purchase online, and these will include the following services:

Take CHARGE will collect your medical information and history from you, and if needed also request information from your healthcare provider (but only with your prior permission).

Take CHARGE will share your medical information and concerns only with medical and other professionals associated with Take CHARGE and analyze it.

Take CHARGE will then provide you with appropriate education, answer your questions, and make recommendations to you about additional things you can do that might be of beneficial to you. For example, Take CHARGE might suggest exercising options which can be done in your own home to maintain or improve your fitness. Take CHARGE may also educate you on how you might benefit by seeking more detailed advice and/or formal consultation from a dietician, a physical therapist, an exercise/fitness trainer, an occupational therapist or other professional (if you are not already seeing one). Hopefully this information will help you improve your health status and better utilize the healthcare resources available to you. It is then up to you to seek the professional healthcare services and receive any treatment.

Take CHARGE will produce a short written report for you listing the education and useful services that you might consider as well as basic information about why the services could be beneficial. You are encouraged to share this information with your healthcare provider for further advice or corrections since they may be privy to more information about you than we are.

Take CHARGE is NOT a referral network but if desired will provide you a partial list of professionals and/or other healthcare services in the area that provide professional services of the type it is recommending you seek. This list is simply to provide you with contact options. We do not endorse or vouch for any individuals or entities on the list.

WHAT YOU AGREE TO DO:
You agree to continue seeing your current healthcare system as you would otherwise do, and to continue following that medical professional’s advice or switch to another healthcare provider of your choosing. We also encourage you to share the Take CHARGE information with your healthcare providers so that they can render their opinions on this information and to help prevent any misunderstandings about your health status and care.

If it appears based on the initial free consultation/evaluation that you might benefit from the information and services offered by Take CHARGE, you agree to pay the following fee/fees through the Take CHARGE website (either via credit card or PayPal):
1) 30-minute consultation blocks at $30/30 minutes/patient. This fee includes any research and discussion time needed by the CHARGE Team as well as time spent with communicating with you. The initial free assessment will provide us with some idea of how many blocks of consulting time is likely to be needed to address your questions and concerns. If additional time is needed to provide you with the most useful information, we will notify you of this and you can purchase additional 30-minute blocks of such consultation time. If, however you decide that you do not wish to purchase additional blocks, we will provide you with the information and recommendations we have gained during this initial time.
2) A 1-month consultation block at $100/month/patient. You will be able to contact us with initial and any subsequent questions or concerns during this 1 month paid period for up to 2.5 hours of consultation time during this month. Again, this fee includes any research and discussion time needed by the CHARGE Team as well as time spent with communicating with you. If additional time is needed to provide you with the most useful information, we will notify you of this and you can purchase additional one-month or 30-minute blocks of such consultation time under the same terms as above. If, however you decide that you do not wish to purchase additional blocks, we will provide you with the information and recommendations we have gained during the time paid for.
3) All fees once paid are non-refundable.

Provide, as appropriate, relevant health information, including medical and personal history information, and access to relevant health-related documents, including my medical records (collectively, the “Heath Information and Documents”) to Take CHARGE, or to provide access to the Health Information and Documents. The relevance of the information shall depend on the questions and concerns posed by you and will be mutually agreed upon.

Reasonably cooperate with requests from Take CHARGE so that it can complete its assessment.

Understand that every effort will be made to protect and keep confidential my Health Information and Documents. Take CHARGE will also not share your health information with any entity outside of Take CHARGE without your prior permission.

Understand that Take CHARGE may use my Health Information and Documents for all purposes related to its development of its verbal and/or written health assessment and recommendation to you. You agree that Take CHARGE may share my Health Information and Documents with its Take CHARGE contractors who specialize in various areas to determine if I might benefit from services in their areas of expertise.

Agree that if Take CHARGE discovers a medical emergency situation or urgent health concern, you will immediately address this with a formal healthcare provider (e.g. urgent care, emergency room, or primary care provider) and not rely on the Take CHARGE to take urgent or emergent healthcare action.

OTHER TERMS OF THE AGREEMENT
Term. This Agreement shall be effective upon from the Effective Date of payment for services and continue on until either Party terminates the Agreement, which either Party may do at any time (the “Term”). Client’s failure or refusal to carry out its obligations – including its general obligation of cooperation or responding to correspondence or providing information as requested – will be deemed a material breach of the agreement and a basis for terminating the Agreement without generating a report. Once fees are paid, they are not refundable.
Entire Agreement. This Agreement contains the entire agreement of the parties and there are no other promises or conditions in any other agreement whether oral or written. This Agreement supersedes any prior written or oral agreements between the parties.
Dispute Resolution. This Contract shall be governed by the laws of the State of Michigan. The venue for any dispute related to the Agreement shall be in Washtenaw County and each Party waives any objections to this venue and consents to the jurisdiction of the Courts in Washtenaw County for this purpose.

In consideration of the foregoing, CLIENT AGREES THAT EXCEPT IN THE CASE OF INJURIES OR HARM TO CLIENT DUE TO THE GROSS NEGLIGENCE OF TAKE CHARGE OF YOUR HEALTH, LLC OR ITS EMPLOYEES, OFFICERS, AGENTS, OR CONTRACTORS (COLLECTIVELY, THE “INDEMNIFIED PARTIES”) AND TO THE MAXIMUM EXTENT PERMITTED BY LAW, CLIENT HEREBY RELEASES AND DISCHARGES ANY AND ALL CLAIMS THAT CLIENT HAS OR MAY HAVE IN THE FUTURE AGAINST THE INDEMNIFIED PARTIES THAT RELATE TO SERVICES PROVIDED BY THE COMPANY, AND INDEMNIFY AND AGREE TO HOLD HARMLESS THE INDEMNIFIED PARTIES AGAINST ANY AND ALL CLAIMS ASSERTED AGAINST THE INDEMNIFIED PARTIES (INCLUDING CLIENT’S CLAIMS) THAT RELATE IN ANY WAY TO THE SERVICES PROVIDED BY TAKE CHARGE OF YOUR HEALTH, LLC TO CLIENT.

CEO, Take CHARGE of Your Health

David Gordon, M.D.

Contact Us

(734) 945-8059
contact@takechargehealth.com

Schedule a Consultation:

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