The Member seeks to enroll the patient identified on Schedule A (the “Patient”) in the Practice’s program to provide Services in exchange for certain Fees (as defined below) pursuant to the terms of this Agreement.

Specialty Care Services.

(a) Services. In exchange for the Fees (as defined below), the Practice agrees to provide services to the Patient, provided by licensed health care providers employed by the Practice (“Providers”): comprehensive psychiatric evaluations, diagnosis and assessment, lab-work, hormonal and digestive assessments, prescriptions and medication management, referrals to additional health services as appropriate, nutritional supplements, additional holistic therapeutic treatment modalities individualized to each patient (the “Services”).

(b) Specialty Services and Programs
Comprehensive Health Happy Hour

This comprehensive functional psychiatric evaluation will determine what areas of your health require healing. This option is great for those who are seeking assessment, or if you have an established provider that you want to continue working with, this evaluation and plan can be an excellent resource for you and your provider to integrate into your established healthcare.

Includes:

Comprehensive Functional Psychiatric Evaluation

Review of medical history, symptoms, inflammatory, digestive, hormonal and lifestyle assessment with consideration of environmental and lifestyle factors

Functional Laboratory Testing to include: Genetics, heavy metals and toxin exposures, food sensitivities, metabolic abnormalities and inflammatory/immunology reports

Personalized Health Treatment Plan with recommendations for therapeutic modalities, lifestyle and supplements/medication management as appropriate

30 minute evaluation follow-up

I M Wellness 6 Month Membership
In becoming an Intuitive Minds Wellness member you will have greater accessibility to your treatment provider, consistent costs and a more individualized methodology of care.
Includes:

Discounted Initial Functional Psychiatric Evaluation ($350)

Functional Laboratory Testing to include: Genetics, heavy metals and toxin exposures, food sensitivities, metabolic abnormalities and inflammatory/immunology reports

Monthly 30 minute treatment visit to include therapy and supplement/medication management a appropriate

Direct access to provider through up to two 15 minute phone calls a month during consultation hours* to offer additional support with any questions or issues that may arise between sessions

50% off any additional appointments within the month

Recommendations for additional therapeutic supports and resources

Access to discounted professional grade supplements

I M Wellness Optimized Program
This program is for those looking for a more intensive approach to accelerate and revitalize their mental health. Throughout the course of 16 weeks, clients will partner with their treatment provider to address the root cause of mental health challenges and address issues through a comprehensive, holistic approach. The program will be catered to address each client’s individualized mental health concerns and needs. Clients will be provided personalized treatment plans and be empowered and supported in developing healthy habits and lifestyle changes to sustain their overall well-being.
Includes:

Discounted Initial Functional Psychiatric Evaluation ($350)

Functional Laboratory Testing to include: Genetics, heavy metals and toxin exposures, food sensitivities, metabolic abnormalities and inflammatory/immunology reports

Monthly 60 minute treatment visit with additional 30 minute follow up

50% off any additional appointments within the month

Direct access to provider through up to two 15 minute phone calls a month during consultation hours* to offer additional support with any questions or issues that may arise between sessions

Personalized monthly wellness plan to address your specific needs and circumstances

Two follow-up monthly support emails to address any issues, questions or concerns with a personalized response email within 24 hours.

Recommendations for additional therapeutic supports and resources

Access to discounted professional grade supplements

(c) Professionalism. The Practice will provide the Services set forth above to the Patient at a level of professionalism and expertise that is consistent with those generally provided by all mental health providers who practice in Florida.

II. Term.

Term. The Term of this Agreement begins on the Effective Date and is in effect until terminated by the Member or the Practice as set forth in Section IV below.

III. Fees.

Fee. In exchange for the Services described above, the Member agrees to pay Practice Fees as set forth below (the “Fees”), Fees are due at the time of the Service:

Initial Psychiatric Evaluation: $450

One (1) hour follow-up visit: $350

Thirty (30) minute follow-up visit: $250

Fifteen (15) minute follow-up visit: $150

Comprehensive Health Happy Hour w/30 minute follow up: $580

- w/Complete Functional Labs: $2030

I M Wellness 6 month Membership: $375/month

- w/Complete Functional Labs, Initial Psychiatric Evaluation: $1,850 at signing, $375 for the next 6 months ($2,250 )
- If paid in full at time of signing, will offer 10% discount: $3,690

I M Wellness Optimized Program w/Complete Functional Labs & Comprehensive Psychiatric Evaluation: $4550

** If you already have labs/Functional Labs completed with another provider, these labs can be reviewed and if there is not a necessity to repeat, the cost of the lab will be deducted from the price of service.
***If your insurance covers the costs of any of the required labs, the covered cost will be deducted from the services

(b) Cancellation. If you change your mind within 24 hours of signing up, we will be sure to issue a full refund.

If you cancel after 48 hours but before your first visit, you may receive a refund, less a $150 service fee.

If you cancel after 48 hours after your first medical visit, you will only be responsible for paying the costs of services you used. We will collect the balance between membership fees paid and fees associated with visits used according to the following schedule:

- $450 per psychiatric evaluation
- $1500 per Functional Lab testing and interpretation

By signing this Agreement and providing applicable financial information, You are permitting the Practice to charge your credit/debit card on file with the Practice, or permitting the Practice to initiate an ACH withdrawal from your checking account.

(b) Fee Changes. The Practice has the right to change the Fees and Ancillary Service Fees (as defined in section III(f)) upon providing 30 days’ written notice to Member before fee changes are enacted.

(c) Payment Plans: Payment plans are available by month for the term of the service and can be arranged between you and your provider.

(d) Declined Payment. If your payment is declined for any reason or You otherwise fail to timely pay the fees described herein, You will be in breach of this Agreement. The Practice will notify you in writing about this breach. If You fail to correct the breach within 10 days of the Practice’s notice, the Practice may immediately terminate the Agreement upon written notice to You.

(e) Late Fees. If Member has an outstanding balance that is not paid within 120 days of the date of the Service (“Late Fees”) the Practice may immediately terminate the Agreement upon written notice to You, and/or refer the Late Fees to a collection agency.

(f) Ancillary Service Fees. Practice offers services in addition to the Services (“Ancillary Services”). Ancillary Services are available upon request or professional recommendation and charged on a per service basis. Practice will make pricing for Ancillary Services available to Member and clearly explain the charges associated with these Ancillary Services before they are provided. Member must pay separately for all Ancillary Services. Ancillary Services may include but are not limited to: (1) genetic testing, (2) allergen and food sensitivity testing, (3) heavy metals exposure testing, and (4) toxin exposure testing.

IV. Termination

(a) Termination For Any Reason. Member and Practice have the absolute and unconditional right to terminate the Agreement without the showing of any cause for termination at any time by providing thirty (30) days’ written notice to the other Party.

(b) Termination by Practice for Cause. The Practice may immediately terminate this Agreement as follows:

(i) The Practice may terminate this Agreement if the Member breaches this Agreement and such breach is not cured, if curable as determined by the Practice, within ten (10) days of Practice’s written notice of such breach.

(ii) The Practice may terminate this Agreement for the Member’s failure to remit Late Fees, as set forth in Section III(d).

V. Non-Participation in Insurance.

The Fees will cover the Services only. The Fees will not cover the Ancillary Services, any services provided by the Practice other than the Services, any services rendered outside of the Practice, hospital services, emergency room visits, urgent care facility visits, appointments with other providers, specialists, radiology, lab tests by outside companies, durable medical equipment, or any services not expressly listed as a Service (the “Excluded Services”). You acknowledge that the Practice is not responsible for any medical bills that the Patient incurs for the Excluded Services, even if the Practice has referred the Patient for such services. You must immediately notify the Practice should the Patient obtain health insurance for the Patient’s personal use. Member acknowledges that this Agreement is not an insurance plan, nor is intended to replace any existing or future health insurance coverage.

VI. Communication Outside the Office.

(a) Privacy. The Member will be provided with methods to contact the Providers via phone, text messaging, video chat, unencrypted email, and other methods of electronic communication (the “Unencrypted Platforms”). You acknowledge that communications via Unencrypted Platforms are not guaranteed to be secure or confidential methods of communication for sending or receiving sensitive personal health information and acknowledge that unencrypted communication is transmitted over a public network that may be intercepted, altered, forwarded, or used without authorization or detection. Further, unencrypted e-mail and text message senders can easily type in the wrong address, and therefore, such communications be received by an unintended recipient. As such, by signing this Agreement and when communicating with the Practice via any of the Unencrypted Platforms, You understand and accept the risks of communication in this manner. You acknowledge that conversations over certain communication platforms with higher levels of data encryption are preferable to the Unencrypted Platforms. You may revoke this authorization at any time by providing written notice to the Practice. The Practice will take all reasonable steps to keep communications confidential and secure. By signing this Agreement, Member authorizes the Practice to communicate with Member and the Patient via the Unencrypted Platforms. Member may revoke this authorization at any time by providing written notice to the Practice and requesting the Practice communicate with Member and the Patient through more secure platforms; provided, however, following any such revocation, the Member acknowledges that if the Member initiates a conversation in which the Member discloses “Protected Health Information (PHI)” on any of the Unencrypted Platforms, the Member has authorized the Practice to communicate with the Member regarding PHI in the same format.

(b) Responses. You agree that if you do not receive a response to an e-mail message, cell phone message, or text communication within 24 hours, You agree to use another means of communication to contact the Practice. Neither the Practice nor the Providers will be liable to you for any loss, cost, injury, or expense caused by, or resulting from, a delay in responding to You.

(c) Member Portal. A personalized Patient portal has been provided to the Patient by a third-party provider for protected and sensitive information (“Portal”). The Portal is an encrypted, internet-based portal. The Patient will be provided with the Patient’s own personal login information that is not to be shared with anyone. Upon request by the Member, the Member will be provided access to the Patient’s personal login information to the extent permitted by applicable law. Notwithstanding the foregoing, the Practice will not provide the Patient’s personal login information to anyone without the Member’s direct written consent except to the extent such disclosure is required by applicable law.

VII. Miscellaneous

(a) Office Hours. The Practice provides ongoing specialty care, not emergency care. The Practice recommends requesting an appointment at least 24-hours in advance. The Practice will use reasonable efforts to schedule appointments at the next available opportunity. The Practice does not provide after-hour visits, which are defined as in-person visits during national holidays, weekends, or evenings after stated office hours. The Patient may leave a message for the Practice through the Portal after stated offers hours and the Practice will strive to respond within 24 hours. If the Patient is experiencing a medical emergency, please contact 911. For immediate assistance, the Patient may also reach out to the National Suicide Prevention Lifeline at 1-800-273-8255, or the Crisis Text Line by texting “home” to 741741.

(b) Independent Medical Judgment. Nothing in this Agreement shall be deemed to influence or construed to influence or affect the Providers’ independent medical judgment on Patient’s behalf.

(c) Severability. If for any reason, any provision of this Agreement shall be deemed, by a court of competent jurisdiction, to be legally invalid or unenforceable in any jurisdiction to which it applies, the validity of the remainder of the Agreement shall not be affected, and that provision shall be deemed modified to the minimum extent necessary to make that provision consistent with applicable law, and in its modified form, that provision shall then be enforceable.

(d) Assignment. This Agreement, and any rights Member or Patient may have under it, may not be assigned or transferred to another individual.

(e) Entire Agreement; Amendment. The Parties understand that this Agreement represents the entire agreement of the Parties and supersedes all prior agreements and understandings between the Parties regarding the subject matter hereof. This Agreement may only be amended by a written agreement signed by the Parties. Member acknowledges that this Agreement is a legal document and creates certain rights and responsibilities. Member also acknowledges that he/she has read and understands the Agreement and the terms and conditions contained herein.

(f) Waiver of Breach. The waiver by either Party of a breach of any of the provisions of this Agreement by the other Party shall not be construed as a waiver of any subsequent breach by such breaching Party.

(g) Notices. Any communication required or permitted to be sent under this Agreement (other than regular Member communication) must be (i) given in writing and (ii) personally delivered or mailed, by prepaid, certified mail or overnight courier, or transmitted by electronic mail transmission (including PDF), to the party to whom such notice or communication is directed, to the mailing address listed on the signature page. Any such notice or communication shall be deemed to have been given on (i) the day such notice or communication is personally delivered, (ii) three (3) days after such notice or communication is mailed by prepaid certified or registered mail, (iii) one (1) working day after such notice or communication is sent by overnight courier, or (iv) the day such notice or communication is sent electronically, provided that the sender has received a confirmation of such electronic transmission. Any changes in address will be communicated to the Parties according to this Section.

(h) Governing Law; Waiver of Jury Trial; Venue. This Agreement shall be governed and construed under the laws of the State of Florida, without regard to conflict of law principles. THE PARTIES INTENTIONALLY AND VOLUNTARILY WAIVE ANY AND ALL RIGHT TO A TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF THIS AGREEMENT OR THE SERVICES CONTEMPLATED HEREBY. Any dispute between Member and the Practice or a respective affiliate and agent arising under or relating to this Agreement shall be resolved in state or federal court with jurisdiction over Pinellas County, Florida. Each Party consents to the jurisdiction of each such court in any such suit, action or proceeding and waives any objection which it may have to the laying of venue of any such suit, action or proceeding in any of such courts.

(i) Attorneys’ Fees. In the event of any dispute over the terms of this Agreement or their enforcement, the prevailing Party shall have its attorneys’ fees and costs (whether before trial, during trial, on appeal, or otherwise) paid by the other Party.

(j) Counterparts. This Agreement may be signed in any number of counterparts, including facsimile and .pdf, and as executed will constitute one and the same Agreement, binding on all Parties hereto.