Patient Rights
Access to Care
- 24/7 direct access to your physician via phone, text, or email
- Same-day or next-day appointments
- Extended appointment times (minimum 30 minutes)
- Annual comprehensive wellness assessment
- Coordination of specialist care
Communication and Privacy
- Direct physician cell phone number and email address
- Secure electronic communication platform
- Complete confidentiality of medical information
- Access to personal health records
Service Quality
- Personalized care plans
- Preventive care services
- Hospital visits when medically necessary
- House calls when appropriate
Patient Responsibilities
Financial Obligations
- Payment of annual membership fee
- Timely payment of any fees not covered by insurance
- Maintenance of valid health insurance coverage
- Notification of insurance changes
Communication
- Provide accurate medical history
- Update contact information promptly
- Notify practice of any changes in health status
- Respond to practice communications in a timely manner
Appointments
- Arrive on time for scheduled appointments
- Provide 24-hour notice for cancellations
- Follow agreed-upon treatment plans
- Participate actively in preventive care
Practice Commitments
- Limited patient panel (maximum 400 patients)
- Same-day appointment availability
- Minimal wait times
- Comprehensive care coordination
- Regular health monitoring
Agreement Term
This agreement is valid for one year from the date of signing and will automatically renew unless terminated by either party with 30 days' written notice.
Signatures
Patient Name: _________________
Date: _________________
Physician Name: _________________
Date: _________________