Release/Waier/Indemnity and Requirements Agreement
This agreement is entered into between Rita Panahi/Rita Panahi, L.Ac., and client who confirms his/her agreement to all of the provisions shown below by making a tele-medicine appointment dietary,herbal and lifestyle consulting with Rita Panahi/Rita Panahi, L.Ac..
As part of this agreement, Rita Panahi/Rita Panahi, L.Ac., does not promise or guarantee protection from future illness. Dietary and lifestyle consulting is considered an alternative procedure and is not a substitute for medical care. Advice offered is designed to give general information that in the past has been found to help people. Advice offered is not designed to be a diagnosis or cure of any disease, injury or medical condition past, present or future, but as an added support. If you are under active medical care, please tell you doctor before undertaking any of the actions suggested during the consulting process. The consulting suggestions should be done in conjunction with ongoing medical treatment and evaluation and not take the place of any treatment.
Additionally, you promise to give Rita Panahi/Rita Panahi, L.Ac. a complete and accurate account of any medical condition(s) that you may have and any medication(s) or drug(s) that you are taking prior to beginning the consulting session(s).
In consideration of their participation in the consulting sessions, the client hereby accepts all risk to client’s health, including the risk of injury or risk of death that may result from such participation and client releases and waives all claims against Rita Panahi/Rita Panahi, L.Ac., and her employees, representatives, estate, heirs, next of kin, and assigns staff (collectively, the Releasees) from the consulting sessions.
The client further hereby agrees to indemnify and hold harmless Rita Panahi/Rita Panahi, L.Ac., and the Releasees from any and all loss, liability, damage to property, injury or death of any person(s) and/or costs court costs, attorneys fees that may incur that relate to or involve in any way the consulting sessions in which he/she participated, regardless of the cause of such damage and/or injury. The client acknowledges that he/she, as the client, is fully responsible for their health and well-being as well as that of their family (where applicable) and releases Rita Panahi/Rita Panahi, L.Ac. and the Releasees from all damage or injury. The client assumes all risks of the consulting, whether or not such risks were created or exacerbated by the consulting.
The client releases Rita Panahi/Rita Panahi, L.Ac., and the Releasees from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law, admiralty or equity, arising from the client’s past or future participation with respect to the consulting.
CHOICE OF LAW, ARBITRATION AND LIMITED REMEDIES
This agreement shall be construed according to the laws of the State of California only no matter where the client resides. This agreement is valid worldwide. In the event that any provision of this Agreement is deemed unenforceable, the remaining portions of the Agreement shall be severed and remain in full force. In the event a dispute arises between the parties, the client agrees to arbitration alone being the form of resolution and the parties will submit to binding arbitration before the American Arbitration Association (Commercial Arbitration and Mediation Center for the Americas Mediation and Arbitration Rules).
Such arbitration shall be conducted by a single arbitrator. The sole remedy that can be awarded to the client in the event that an award is granted in arbitration is refund of the entire consulting fee. Without limiting the generality of the foregoing, no award of consequential or other damages may be granted to the client. If the terms of this Agreement are acceptable, please make your appointment. By doing so, the client acknowledges that he/she understands, accepts and agrees to abide by the terms hereof.
I HAVE CAREFULLY READ THIS AGREEMENT or had it read to me in my native language AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN CONSULTING AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT OR OMISSION. I ALSO ASSERT THAT I AM OVER THE AGE OF 18 AND HAVE SUFFICIENT MENTAL CAPACITY TO ENTER INTO A LEGAL AGREEMENT ON MY OWN BEHALF OR THAT OF OTHERS.
AUTHORIZATION FOR PATIENT EMAILS AND PHONE MESSAGES
I also authorize Rita Panahi/Rita Panahi, L.Ac. to leave private or confidential health information messages on my voice mail, send a text message or email to the information I have provided.