NP EMPOWERED WELLNESS
Weight Management Membership Agreement
Monthly Fee: $350
This Membership Agreement (“Agreement”) is entered into between:
Client and NP Empowered Wellness PC
1. Membership Services
As part of the Weight Management Membership, Member will receive:
- Initial consultation and health assessment
- Monthly follow-up visits (in person or virtual)
- Prescription management of weight loss medications (e.g., GLP-1s or other medications as medically appropriate)
- Ongoing support for nutrition, fitness, and metabolic health
- Coordination of lab testing (labs billed separately)
- Messaging access via patient portal during business hours
- Monthly B12 or MIC/B12 injection (if clinically appropriate)
Note: Medication costs and lab work are not included in this membership fee and are billed separately through third-party pharmacies and labs. Insurance may be used where applicable.
2. Payment Terms
- Member agrees to pay $350/month, auto-charged to the card on file.
- First payment is due on the start date of the agreement.
- Membership auto-renews monthly unless canceled with written notice (see Section 5).
- Late or declined payments may result in service suspension or cancellation.
3. Term
- Minimum commitment: 2 months
- After 2 months, this Agreement continues month-to-month unless terminated by either party with 30 days’ notice.
4. Member Responsibilities
- Member agrees to follow treatment plans and participate actively in their health program.
- Member agrees to disclose complete and accurate medical history.
- Member must notify Provider of any changes to their health, medications, or contact/payment information.
5. Cancellation Policy
- A 30-day written notice is required to cancel the membership.
- No refunds will be given for partial months or unused services.
- If Member cancels before the 2-month minimum, the remaining month(s) will be charged.
6. Limitations of Membership
This membership is not insurance and is not a substitute for comprehensive health insurance coverage. Membership only includes the services listed in Section 1.
Emergency services, specialist care, imaging, and certain labs or prescriptions may require outside referrals and are not covered by this agreement.
7. Termination
Provider may terminate this agreement at any time for non-compliance, inappropriate behavior, non-payment, or if Provider deems that continued care is not appropriate.
8. Dispute Resolution
Any disputes arising out of this Agreement shall be resolved through binding arbitration in the state of California.
9. Acknowledgment and Signature
By signing below, Member acknowledges they have read, understood, and agreed to the terms and conditions of this Membership Agreement.
