Welcome to our ENGAGEMENT AGREEMENT
Please review this Agreement carefully. If you have any questions, concerns, or issues regarding the content, please contact us for clarification. You may also want to have your own attorney review this document.
THIS AGREEMENT is made effective as of the day agreeing to the Executive Health Navigation Engagement Agreement (the “Effective Date”) by and between Executive Health Coaching LLC dba Executive Health Navigation (the “Company”) and (the “Client”). Client and Company (sometimes collectively referred to as the “Parties”) agree to the following terms:
Services - The Client is engaging the Company for the purposes of Healthcare System Navigation Consulting.
IMPORTANT – Executive Health Coaching, LLC does not provide a medical diagnosis, or medical treatment or render medical advice. Client acknowledges that they have retained their own physician, therapist, and medical professional for the purposes of obtaining such medical or surgical advice, if and when it is needed and appropriate.
1. Term of Agreement. The term of this Agreement will start on the Effective Date and will continue until the Agreement is terminated by either party, as provided below.
2. Services Requested. Company will provide the consulting services requested and agreed upon as set forth above (referred to as the “Services”). Client shall perform all actions and provide all documentation necessary for the Company to render the Services, including, but not limited to, authorizing various parties to speak with the Company if required, and completing and signing applicable HIPAA forms.
3. Rates, Fees & Retainers. Company will provide the Services to Client for a Retainer (the “Initial Retainer” to be initially agreed upon), which is due upon engagement of this Agreement and compulsory prior to services are initiated. Company shall not begin work or provide any Services whatsoever until the Initial Retainer is received, deposited, and cleared in the Company’s bank account. If the Client terminates the Agreement before the balance of the Retainer has been exhausted or if a balance remains after the Company’s time and expenses have been accounted for, the remainder of the Initial Retainer will be refunded to Client.
4. On-Going Fees. In the event the Services are rendered on an ongoing basis, the Client shall pay the mutually agreed amount to the Company. Client shall pay the amount due within 3 days of Company’s email request. Company may suspend or discontinue its performance of Services until Client pays the amount necessary. Client’s failure to pay same within 10 days of Company’s request shall be grounds for termination of this Agreement. Any such termination by Company shall not relieve Client from its obligation to pay Company all amounts due under this Agreement.
5. Payments. Payments may be made to Company by PayPal, Zelle, Venmo, Bank or Certified Check, Money Order, Bank Wire Transfer, or Cash. Personal Checks or Credit Card Payments may be accepted on a case-by-case basis. Any Bank or Certified Checks are to be made payable to Executive Health Coaching, LLC, and mailed as directed on the invoice.
6. Reimbursement of Expenses (if applicable). In addition to the retainer, if travel or other expenses are required during the course of the work, Company will request preapproval for reimbursement prior to incurring such expense.
7. Termination. Either Client or Company may terminate this Agreement at any time and for any reason, upon written notice to the other Party (an initial email copy is acceptable, to be followed by a hard copy by mail). If either Party terminates this Agreement, all amounts due to Company at the time of termination will be immediately due and payable.
8. Governing Law and Forum. This Agreement shall be governed by and construed in accordance with the laws of the State of Florida, without regard to its conflicts of law provisions. Any disputes arising in connection with this Agreement shall be litigated in the Courts of Broward County, Florida. Prevailing party shall be entitled to all reasonable legal fees and costs incurred.
9. Waiver and Amendment. Any waiver by Company of any of the terms or conditions of this Agreement shall not constitute an ongoing or future waiver of such terms and conditions. This Agreement may not be amended or modified, except by a duly signed writing referring to the specific provision to be amended or modified.
10. Disclaimer and Limitation of Liability. Company is a professional, consulting, and private patient advocacy business. Client acknowledges that Company is NOT providing Client with any medical advice, legal advice, or professional advice of any kind. Client should seek medical advice from one or more duly licensed physicians before making any decision related to medical care. Company’s total liability for the Services rendered in connection with this Agreement shall be limited to the fees paid by Client.
11. Entire Agreement. This Agreement constitutes the entire Agreement with respect to the subject matter hereof and supersedes all other prior agreements and understandings, both written and oral, among the Parties hereto and their affiliates. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original but all of which shall constitute one and the same instrument.
12. Authorization to Release Information. During the course of providing the Services, Client hereby authorizes the Company (Executive Health Coaching LLC) and its representatives to obtain, release and exchange Client’s personal medical information with other unrelated parties at the full discretion of the Company. Client waives their right to privacy regarding Protected Health Information (PHI) and the Health Insurance Portability Accountability Act of 1996 (HIPAA). The communication may be in non-complying methods of communication including but not limited to telephonic conversations, text messaging, pictures, emails, attachments, documents, and facsimiles. Client understands that once my information is released, the recipient might redisclose it and that the Company has no control over the information. In the event Client wishes to cancel this authorization, Client may do so by providing a simple one-sentence written letter stating: “I wish to cancel my authorization to release information”, signed and dated by the Client.
Client has read, understood, and is in agreement with the terms and conditions of this Agreement:
Executive Health Coaching LLC dba Executive Health Navigation
Brian Dooreck, Managing Member
Phone: (786) 505-6404