Forbes VIP Health

This agreement is effective on the date you pay your enrollment fee. It will be effective for one year from the date of enrollment and your monthly subscription fee will be due and deducted automatically via your payment method (debit/credit card) each month. If the patient or the provider desires to terminate the agreement before the date of renewal date in one year, they may do so by providing at least a 30 day written notice by secure email to/from the practice email. Otherwise the agreement will automatically renew as long as the patient remains paid and current in their subscription plan and meets eligibility criteria per the membership plan description.

The patient agrees to one of the following payment schedules and that they meet age criteria for the membership plan they are electing:

There will be a one-time, non-refundable enrollment fee of $50. charged at the time you enroll in the direct primary care practice of Forbes VIP Health, PLLC. member.

Patient agrees to provide a valid ACH/credit card on file for automatic electronic deduction for payment for monthly membership plan fees.

If Forbes VIP Health, PLLC determines that it is necessary to terminate their relationship with the patient at any time, they reserve the right to do so. Such termination will be done in accordance with applicable laws and statutes.

In the event a patient’s ACH/credit/debit card expires or is declined at the time the automatic monthly membership payment is due, and Forbes VIP Health, PLLC does not receive payment via a newly provided ACH/valid non expired credit card from the patient within 7 days of due date, the patient agrees that it is his/her responsibility to communicate via secure email with Forbes VIP Health, PLLC that he/she wishes to remain a patient with the practice and makes payment in full through the provided payment link. Otherwise patient understands this nonpayment will result in discharge from the practice, in accordance with applicable regulations and statutes.

There is a reinstatement fee for patients who have intentionally or unintentionally allowed their membership to lapse, or have cancelled it, assuming that Forbes VIP Health, PLLC. and the provider agree to resume the patient’s care. That fee will be a non-refundable $200.

The patient(s) understand that the services provided by Forbes VIP Health, PLLC. do not constitute health insurance. A Direct Primary Care membership by itself does not meet requirements of any federal law mandating individuals to purchase health insurance. The membership fees charged by Forbes VIP Health, PLLC. may not be reimbursed or apply towards a deductible under a health insurance policy with an insurer. This agreement is a personal service contract/retainer with your personal direct primary care provider with Forbes VIP Health, PLLC. Our practice specifically encourages patients to have some time of health insurance plan to cover catastrophic medical expenses. Types of plans may include, but are not limited to: commercial health insurance policies, faith based health sharing ministries, Medicare, Medicaid, Tricare VA care or other government funded insurance which are not billed under the direct primary care.

Forbes VIP Health, PLLC. does not participate in any insurance company’s network and does not submit claims to insurance for subscribed direct primary care nor telehealth patients. We cannot make any guarantees about patients receiving reimbursement from any insurance company should they submit receipts to said company. If a patient is a Medicare beneficiary, or will become one soon, in order to enroll as a patient of Forbes VIP Health, PLLC, they must sign an additional agreement stating specifically that they understand that no services provided can be reimbursed by Medicare. This agreement applies only to services provided by Thais R Forbes, APRN, FNP-C with Forbes VIP Health, PLLC. It in no way limits services patients may receive from other providers who accept Medicare

Up to 12 telehealth visits per year are included in your direct primary care plan with Forbes VIP Health, PLLC and in cases where Forbes VIP Health, PLLC deems is it clinically necessary for an in person visit, the patient agrees to pay the additional fee required for a mobile visit or to seek the recommended services at an urgent care facility or hospital of the patient’s choosing for evaluation.

During times when Forbes VIP Health, PLLC. is closed (including nights, weekends, holidays, and vacations), there is always a provider available by telephone. Please use discretion when calling the after-hours on call provider: call only for matters which cannot wait until the office re-opens. For urgent and potentially life threatening concerns, the patient agrees to call 911 or present to the nearest emergency room for evaluation. For less urgent matters, there is an option to leave a voicemail which will be addressed the next business day. Established patients may also send non-urgent e-mails through the patient portal. Any messages sent when the office is not open will be answered the next business day. The patient agrees not to send urgent or emergency issues via text/SMS message. All telehealth and mobile visits are by appointment only. If you have a serious injury or illness that threatens life or limb, call 911 or proceed to the nearest emergency room. Let us know if you have been treated by any other facility or provider and ask that your treatment notes be released to our practice for continuity of care.

If there is a change of any relevant law, regulation, or rule, federal, state, or local, which affects the terms of this Agreement, the patient and Forbes VIP Health, PLLC. both agree to amend this Agreement to comply with the law.