Agreement for Weight Loss Program Membership
This Membership Agreement is made effective by signing and dating this form, between the undersigned member and New Creation Health & Wellness, LLC. In consideration of the mutual promises and undertakings set forth below and for other valuable consideration, receipt and sufficiency of which are hereby acknowledged by the Parties, and intending to be legally bound, the Parties hereby mutually agree, as follows:
1. Patient-Clinician Relationship
By your signature, you acknowledge that you are voluntarily becoming a client of New Creation Health & Wellness, LLC (NCHW) and its medical group or affiliated clinician. As a New Creation Health & Wellness patient, those services described in Section 2 below will be made available to you pursuant to the terms of this Membership Agreement.
2. New Creation Health & Wellness Services
Health Care Services: As a patient, you are eligible to receive a set of ongoing weight care services as offered by your individual clinician from among those listed in our Detailed Service List (attached below and also available at New Creation Health & Wellness, LLC WEBSITE. You are also eligible to receive on-going mobile phone, email, and digital application access. During the term of this Agreement, the Weight Loss Care Services provided by New Creation Health & Wellness, LLC may be subject to change by New Creation Health & Wellness from time to time. Such changes, if any, shall be reflected on the Detailed Service List.
If you have a pre-existing medical condition, please contact us first to learn how you may benefit from our weight loss care services. Pre-existing medical conditions do not disqualify you from enrolling in our program, but we will customize the service to ensure your safety.
By entering into this Membership Agreement, you acknowledge that New Creation Health & Wellness, LLC does not provide health insurance coverage and that this is not a contract for insurance. New Creation Health & Wellness, LLC provides only the Health Care Services specifically described herein and additional costs may be incurred for medications, non-basic laboratory tests and any services required outside of New Creation Health & Wellness services. New Creation Health & Wellness, LLC encourages you to continue to see your primary care and other health specialist, if any, for your health management.
Fees and Payment
MEMBERSHIP FEE: New Creation Health & Wellness, LLC charges an annual Membership Fee (with the option to pay in one full payment, two payments within 3 months, and four payments within six (6) months) per Member to include all Covered Healthcare Services included on the Detailed Services List. All payments must be complete within six months of signing this agreement.
I agree to and shall pay the Member Fee as provided in the Membership Agreement. Unless this Agreement is not renewed, as provided in Section 6 (below), subsequently, I understand I will be billed for the Membership Fee for each Renewal Year prior to the beginning of each Renewal Year, and I agree to automatic payment from my bank or my provided credit card or to pay the invoiced Membership Fee within 10 days after the date of the invoice. In order to facilitate the administration of the Program, New Creation Health & Wellness, LLC may appoint a third party affiliate to perform all billing and collections functions associated with the Member Fee. Accordingly, you agree to submit all payments of Member Fee to such affiliate.
- Member must be aged 18 years or older: Please see our pricing section for fees (subject to change when needed. However, your fees will remain according to your signed agreement).
- After the first year, you can continue with an annually pre-paid memberships for only $365.00/year ($1.00 a day) (See Detailed Service List).
New Creation Health & Wellness, LLC also charges a one-time, non-refundable $395.00 Screening and Assessment fee payable with your registration.
Payment transactions declined due to insufficient funds or expired cards will result in an additional fee of $50 + any technology / processing fees applied at the time of the transaction. Failure to comply with payment terms may result in termination of your membership. Services will not be rendered for patients with past due accounts.
Most, but not all, of the services described in Section 2, are covered by the Membership Fee, subject to the limitations set forth in this Membership Agreement.
- Some Health Care Services provided by New Creation Health & Wellness. LLC are not covered by the Membership Fee (Non-Covered Health Care Services). The fee schedule for these services will be provided to you upon your request. New Creation Health & Wellness may amend the fee schedule from time to time in its sole and absolute discretion and without prior notice.
- Any Non-Covered Service requested and received must be paid at the time the service is provided.:
- All Fees paid are non-refundable. This includes all Fees that may have been paid whether such were paid on the one, two, or four payments plan basis. Example of fees: fees charged by independent merchants for transactions.
4. Your Medical Information
Your privacy is very important to us, and you control the use of your personal information. New Creation Health & Wellness, LLC has put important safeguards in place to make sure your medical information is protected and safe to maintain its confidentiality.
New Creation Health & Wellness seeks to work together with you to give you the best health care possible. Having access to your medical information will help your NCHW provider give you the best possible care because he/she will have the most up-to-date information about your health. Therefore, as allowed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and to help us give you the right care, in the right place and at the right time, your authorized health agents may electronically share with us your health-related information (including your “protected health information” as defined by HIPAA). Such shared health-related information may include things like visits to the doctor or hospital, medical conditions, current and past prescriptions, biometric data (height, weight, body fat percentage, etc.) and other health status-related information.
5. Digital Communications Risks and Conditions
New Creation Health & Wellness, LLC offers members the ability to send and receive emails and texts to and from their care team. While New Creation Health & Wellness, LLC takes many precautions to protect your information and the security of the emails and texts it sends, there are still risks.
Transmitting patient information by email or text has several risks. These risks include but are not limited to the following:
- Email and texts can be circulated, forwarded, stored electronically and on paper, and broadcast to unintended recipients.
- Email and text senders can readily misaddress an email or text.
- Email and texts can be intercepted, altered, forwarded or used without authorization or detection.
- Emails and texts may not be secure, and therefore it is possible that the confidentiality of such communications may be breached by a third party.
- Email and text service providers may have access to your emails and texts.
New Creation Health & Wellness, LLC is not liable for improper disclosure of confidential information that is not caused by New Creation Health & Wellness misconduct. You must acknowledge and consent to the following conditions:
- Email and text should not be used for urgent or emergency situations. Please call 911 in the event of a medical emergency.
- Per your request, New Creation Health & Wellness, LLC may send emails or texts to you as necessary for your diagnosis, treatment, billing, eligibility and other handling.
- You should not use email or text for sensitive communications (e.g., AIDS/HIV, mental health, developmental disability or substance abuse).
- You are responsible for informing New Creation Health & Wellness, LLC, in writing, if you want to cease or limit email or text communications with us. You may do so at any time without reason or explanation.
- You are responsible for protecting your email account or telephone password or other means of access to your email or text. New Creation Health & Wellness, LLC is not liable for breaches of confidentiality involving your email or telephone accounts that are caused by you or any third party.
By signing this Membership Agreement, you acknowledge that you have received and read the above information. In addition, you agree to any instructions that New Creation Health & Wellness, LLC may impose regarding the sending and receipt of email or text communications containing patient information.
Recommendations and Instructions:
If you wish to send and receive emails or texts from New Creation Health & Wellness, LLC regarding your care and treatment, you:
- Should limit or avoid use of public computers and public networks.
- Should promptly inform New Creation Health & Wellness of changes in your email address or telephone number.
- Before sending emails or texts containing personal health information to New Creation Health & Wellness, you should:
- Ensure the email or text is addressed to the intended recipient.
- List the key topic in the email subject line.
- Put your name in the body of the email or text.
- Take precautions to preserve the confidentiality of your emails or texts. Once New Creation Health & Wellness sends an email or text from its network, it has no control over its confidentiality or security.
Note: Patients can communicate securely with New Creation Health & Wellness via the New Creation Health & Wellness Patient Portal or our Spruce Application. You will receive an invitation to download the invitation.
6. Term and Termination
This Membership Agreement shall begin upon the Effective Date and shall continue for one year to the first anniversary date unless it is terminated within ten (10) days of the effective date by submission of a Membership Cancellation Form. In this case, you will only be charged the registration fee and one month of the Membership Fee to recover any associated transactional fees. $250.00 will be deducted from your balance if the weight kit has been shipped to you.
This Agreement will automatically renew on the first anniversary date and all subsequent anniversary dates thereof unless you provide sixty (60) days written notice prior to the anniversary date, not less than 30 days prior to the expiration. However, I understand that the Agreement will not automatically renew if I am not current in all my financial obligations to New Creation Health & Wellness, LLC
Notwithstanding the above, in order to terminate this Membership Agreement, you must complete, sign and submit (via email or fax) to New Creation Health & Wellness, LLC a Membership Cancellation Form. Membership Cancellation Forms can be obtained by contacting New Creation Health & Wellness, LLC. The date of termination shall be the last day of the month that follows the month in which the Membership Cancellation Form was received. By cancelling your membership before the yearly maturation, you agree to pay/return the full cost of your weight loss kit in the amount of $250.00. Additionally, there is a $250.00 cancellation fee.
Upon cancellation, after payment is received for all fees and periods prior to the termination of this Membership Agreement, you will not be responsible for any further payments.
New Creation Health & Wellness, LLC may terminate this Membership Agreement at any time, subject to any professional obligations.
7. New Creation Health & Wellness, LLC Terms
- If any term, provision, covenant or condition of this Membership Agreement is held by a court of competent jurisdiction to be invalid, void or unenforceable, the remaining provisions will remain in full force and effect and will in no way be affected, impaired or invalidated.
- This Membership Agreement will be governed by and construed in accordance with the laws of the state in which the medical office of New Creation Health & Wellness LLC is located. By signing the Membership Agreement, you agree to have any dispute arising out of the Membership Agreement decided by neutral binding arbitration rather than by a jury or court trial. Any dispute will be submitted to arbitration in the county in the state of Virginia. The decision in arbitration shall be conclusive and binding on you and New Creation Health & Wellness, LLC. All arbitration provisions shall be governed by, construed and enforced in accordance with the Federal Arbitration Act.
- This Membership Agreement is non-transferable.
Except as required by applicable law, neither New Creation Health & Wellness, LLC nor any of its agents, consultants or representatives shall be liable to you for any damages or liability arising out of or related to the Agreement. In any event, each parties’ liability under the Agreement, shall be limited to the amount that is equal to the aggregate Membership Fees paid by you during the twelve-month period preceding the date on which the claim arises. In no event will any party be liable for any indirect, consequential, special or punitive damages of any kind, whether arising in contract, tort, strict liability or otherwise, to the full extent permitted by the applicable law arising out of or related to the Agreement.
If you have a complaint, please contact New Creation Health & Wellness, LLC in any of the following ways:
Email: [email protected]
Mail: 4107 Plank Road A, Fredericksburg VA 22407..
New Creation Health & Wellness, LLC Detailed Service List
- Covered Weight Loss Services
○Initial fee: Registration
Health Assessment and findings analysis
Behavioral and metabolic surveys and findings
Two initial visits
Membership Fee (First Year)
- Ongoing medical weight care
- Weekly x 4 video appointments
- Then every other weekly video appointments
- Behavioral, nutritional, and exercise coaching
- Daily Access to NCHW digital platform and interactive application for additional education, progress tracking, and communication with your medical provider.
- Recipes to facilitate healthy lifestyle
- Medication prescription order as needed (You will pay for the cost of the medications).
- Discounted weight loss kit (Smart scale, Fitbit, blood pressure cuff, exercise bands, and a shaker).
- Lab re-evaluation at 12 months
- Non-Covered Services under the membership fee
○ Meal replacements if desired- Order and pay directly online through our website
○ Lipotropic injection if desired
Prescription medications cost
Compounded medications if needed
- Membership Fee Consecutive Year
Continued access to our digital platform and health resources
Continued access to recipes to facilitate healthy lifestyle
10% off on any services and products
Two scheduled semi-annual 30-minutes video conferences with your medical practitioner.