Terms of Service Informed Consent/Authorization
The following Statement of Informed Consent and Authorization establishes the protocol established by HealthyKidneyInc.com in relation to the services and/or products being offered by HealthyKidneyInc.com. This may include access to in-person, electronic and/or telephonic consultation services. You as the client/consumer agree to accept responsibility for your decision to seek any and all services/products offered by HealthyKidneyInc.com.
To ensure compliance with these Terms, HealthyKidneyInc.com reserves the right, but not the obligation, to monitor usage of any services and/or products offered or obtained through HealthyKidneyInc.com. HealthyKidneyInc.com can, in its sole discretion, refuse access to any and all services and/or products due to actual, potential or perceived misuse/abuse of the site, related services/products, or for noncompliance with Terms.
To process and fulfill any service requests, you must verify that you have read and understand these conditions, including the Statement of Client Responsibility.
Statement of Client Responsibility
By transmitting my health/other personally identifiable information in connection with my request for services/products, I assert the following to be truthful statements:
- I am at least 21 years of age.
- I am competent to use the services and/or products offered by HealthyKidneyInc.com, and I fully comprehend the nature of the services/products provided.
- I voluntarily choose to seek out the products and/or services offered through HealthyKidneyInc.com.
- I recognize that the consultant reviewing my Health Information may or may not make recommendations based on my responses.
- I am aware that my failure to provide truthful, accurate and complete information to the associate, consultant and/or any other providers could result in inappropriate treatment decisions that may be harmful or not be safe and effective. Therefore, I have responded truthfully and accurately and have completely disclosed any and all information concerning my health and medical history that could be relevant to my current condition and need for treatment and/or medication.
- I have been seen by a physician and/or had a medical history evaluation within one year of requesting services/products from HealthyKidneyInc.com. I will undergo a physical examination every year to ensure that my request for health products/services is appropriate, and to inform my personal physician about the products ordered or purchased, as applicable, through HealthyKidneyInc.com.
- I understand that HealthyKidneyInc.com receives electronic transmissions of any consultation/service requests; directs my information to a consultant for his/her review and response in accordance with the consultant’s professional judgment as to my request.
- I will make the associate/consultant aware of any changes to my medical condition in the event I return seeking services or products of any kind whatsoever.
- I will contact my physician if I have questions, difficulties or complications with recommended products and/or treatment(s).
- I understand that I am able to contact the associate/consultant who reviews my information either through the customer service number or email address posted on the web site.
- I understand that I will be given the opportunity to ask the associate/consultant any and all questions about any treatments/regimens/products that have been recommended for me.
- If paying by credit or debit card, I am the owner of that credit or debit card or I am permitted by law to use such credit card.
- I understand that there are risks as well as benefits in undergoing any kind of meditation regimen or consultation service.
- I understand that the consultant is an independent, U.S. licensed practitioner; and not a physician.
Client Agreement and Acknowledgement:
As a potential client/customer of the services provided by or through HealthyKidneyInc.com, I hereby understand, accept, and agree to the following:
In order to determine your compliance with these Terms, we reserve the right to monitor access to/use of HealthyKidneyInc.com and any related services and/or products. HealthyKidneyInc.com may, in its sole discretion, refuse to provide access to the site or services due to actual or potential misuse of the site, these Services, or for noncompliance with these Terms.
I am voluntarily providing my health and medical information for the purposes of obtaining services through HealthyKidneyInc.com and realize no physical in-person examinations will be conducted.
I acknowledge that Dr. Robert Galarowicz, HealthyKidneyInc.com as well as any of its employees do not practice medicine and are not healthcare service providers. Additionally, I acknowledge that HealthyKidneyInc.com cannot and does not direct, control or influence the opinions or decisions made by the consultant/affiliate/associate and/or any other assigned employee with respect to my care.
I agree that any dispute arising out of/related to the provision of services by HealthyKidneyInc.com, the consultant and/or any other employee, or by their affiliates, employees, partners and agents, will be subject to mandatory mediation. Should mediation fail to resolve the dispute issue(s), said dispute shall be subject to final and binding arbitration and that all parties will agree to be bound by the arbitration, which will be enforceable in a court and that the parties waive any rights to bring suit in favor of agreeing to binding arbitration. Any mediation, arbitration, administrative proceedings, or other proceedings shall be held in Bergen County, NJ, unless the parties agree otherwise, and shall be governed by the substantive law of the State of NJ without regard to conflicts of law.
I accept all risks, known and unknown, involved in, arising from or related to using the prescribed products or treatment. Subject to and without waiving any rights that may be conferred upon me under state or federal law, I will not seek indemnification and/or damages whatsoever of any kind from HealthyKidneyInc.com for negligent, reckless or intentional acts or omissions, and I hereby hold harmless HealthyKidneyInc.com from and against any and all liability relating to or arising out of my request for or receipt of treatment from HealthyKidneyInc.com.
I hereby release HealthyKidneyInc.com and the consultant and other employees from any and all claims that the associate/consultant acted below the requisite standard of care on the basis that the associate/consultant did not personally examine me. I acknowledge that any and all testimonials and/or reviews expressed by service provider represent only a cross section of the range of results that appear to be typical with these products and/or services.
I hereby acknowledge that all information and service provided by or through this web site and telephone service are provided “as is” without warranty of any kind, expressed or implied.
If any provision of this agreement is held to be illegal, void or unenforceable, then this agreement may be modified or amended only to the extent necessary to enable the remaining provisions to be of force and effect to the maximum degree.
Client Authorization for Release of Individually Identifiable Health Information
In connection with providing certain individually identifiable health information to HealthyKidneyInc.com, I authorize the following:
I hereby HealthyKidneyInc.com to use and disclose any of my health information, including all individually identifiable health information obtained through documents, forms and/or telephone consultations for the purpose of treatment, payment and health care operations. This authorization additionally includes, but is not limited to, any health information relating to HIV and other sexually transmitted diseases, mental health or disease, drug or alcohol treatments.
HealthyKidneyInc.com ’s privacy notice provides more detailed information about our privacy policies, and you are encouraged to review it before agreeing to this authorization. I declare under penalty of perjury that the foregoing is true and correct. My agreement to this statement constitutes my signature.
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