CONTRACT FOR THE PROVISION OF BEDSIDE ADVOCACY AND SUPPORT
THIS CONTRACT is hereby entered into on this ………………day of ……..…………….Two Thousand and ……………………………
BETWEEN
- ANGELA ALLEN, a Registered Nurse and the Director of Concierge Endometriosis Care hereinafter referred to as “CONCIERGE ENDOMETRIOSIS CARE” which expression shall where the context so admits include its personal representatives and assignees)
AND
- ……………………………………………of ………………………… (ADDRESS) hereinafter referred to as “THE PATIENT” which expression shall where the context so admits include his personal representatives and assignees).
NOW THESE TERMS ARE AGREED UPON BY THE PARTIES:
- CONCIERGE ENDOMETRIOSIS CARE is a ………………….. (company/consultancy firm) which provides bedside advocacy including consultancy and liaison with other medical professionals experienced in the issue at hand, for patients dealing with endometriosis and endometriosis excision surgery.
- Concierge Endometriosis Care shall work in cooperation with the Patient’s treatment team which may include the surgeon, the neurologist and physical therapist among other medical personnel; and shall ensure that the liaison is kept as professional and as smooth as possible.
- In the event that Concierge Endometriosis Care is not able to satisfactorily advocate, consult and/or liaise for the Patient, Concierge Endometriosis Care shall promptly inform the Patient of the inability. Further, should the Patient be desirous of recommendations, Concierge Endometriosis Care shall make recommendations of other facilities that are better equipped to handle the Patient’s case.
- Whereas Concierge Endometriosis Care undertakes to bring forth professionalism and good faith in all its dealings with the Patient, Concierge Endometriosis Care shall not be liable for the outcome of the consultancy, liaison and advocacy that they may have given.
- The Patient shall disclose to Concierge Endometriosis Care all material information regarding the case at hand including any treatment sought, any pending treatment and/or procedures or medication that have been recommended in the past.
- The Patient’s failure to disclose any material information shall absolve Concierge Endometriosis Care of any liability that may be suffered by the Patient as a result of such non-disclosure.
- The Patient shall pay USD ………….for the services rendered an amount that shall be payable as a one-off sum or in ………….. installments of USD ……………each.
- The amount agreed upon shall be paid ……………………….(In cash, bank transfer ……etc)
- This Contract shall commence upon the date of full execution by all parties and expire when the terms of this contract have lapsed or when the parties shall agree.
- The terms and conditions of this contract shall be binding upon the parties herein and any dispute arising shall be referred to …………
- This Contract contains the whole agreement and understanding between the parties herein and supersedes all previous contracts (if any) whether written or oral between the parties in respect of such matters.
IN WITNESS whereof the parties hereto have executed this Contract the day and year hereinabove written.
SIGNED by the parties: )
ANGELA ALLEN ) _________________ )
FOR: )
CONCIERGE ENDOMETRIOSIS CARE )
) ) )
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AND )
PATIENT ) _________________
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WITNESSED BY: – ) ___________________
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