Medical Terms of Service

Last updated: June 1, 2020

These Medical Terms of Service (the Medical Services Terms) govern your use of the Medical Services, including the Telehealth Services (the Medical Services) provided by Shanna MD PLLC a/k/a Goals Healthcare (Goals Healthcare) Please read the Medical Services Terms carefully before using the Medical Services. By using the Medical Services, including the Telehealth Services, you agree to be bound by these Terms. If you are accepting these Medical Services Terms for another person (Family Member) you agree to the terms, conditions, and notices contained or referenced herein on behalf of such Family Member. Goals Healthcare also provides membership and other non-medical services to consumers, and the Goals Healthcare Membership Terms govern your use of those services provided by Goals Healthcare. Please read the Membership Terms of Service carefully before using our services. Please refer to our HIPAA Privacy Policy to learn how Goals Healthcare collects, uses, shares and protects your Protected Health Information (PHI) defined under the Health Insurance Portability and Accountability Act of 1996 or HIPAA.

DO NOT USE THE MEDICAL SERVICES INCLUDING TELEHEALTH SERVICES FOR EMERGENCY OR URGENT MATTERS. FOR ALL URGENT MATTERS CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM OR URGENT CARE FACILITY.

A) Updates to the Medical Services Terms

We may modify these Medical Services Terms from time to time. We will notify you of material changes by posting the amended terms on the Goals Healthcare website at least thirty (30) days before the effective date of the changes. If you do not agree with the proposed changes, you should discontinue your use of the Medical Services before the effective date of the change. If you continue using the Medical Services after the effective date, you will be bound by the updated Medical Services Terms.

B) Your Financial Responsibility Including Assignment of Benefits

You agree to pay Goals Healthcare all applicable charges at the prices then in effect for the Medical Services provided to you or another person on whose behalf you are accepting these Medical Services Terms and/or payment responsibility (such as your children or other family members) (Covered Family Members) will be charged for the Medical Services, including Complementary and Alternative Services (AS) provided to you or your Covered Family Member by a Goals Healthcare service provider (each, a Provider) you authorize Goals Healthcare to charge your chosen payment method (your “Payment Method”) for the Medical Services provided to you or your Covered Family Member. If your Payment Method is invalid at the time payment is due, you agree to pay all amounts due upon demand. The third party services provider who manages your Payment Method may impose terms and conditions on you, which are independent of these Medical Services Terms, and you agree to comply with all of those terms. Goals Healthcare may accumulate charges that you’ve incurred for the Medical Services and submit them as one or more aggregate charges during or at the end of each billing cycle. Goals Healthcare reserves the right to correct any billing errors or mistakes even if payment has already been requested or received. If you provide information about your health insurance or health plan, that will be deemed your authorization for us to submit claims for covered Medical Services to your health insurer or health plan. You hereby assign or otherwise authorize payment of medical benefits to us for the Medical Services provided to you or your Covered Family Member. You authorize the release of any medical or other information necessary to process any claims for the Medical Services provided. You or the Family Member understand that if you or a Family Member elect or choose to obtain services from a provider that you know or who has been disclosed as not participating in your health plan network, you will be responsible for the charges billed by that provider to you. You further understand that you can request to see the estimated fees for healthcare services of providers who are outside of your health plan and/or network prior to receiving services.

YOU AND/OR FAMILY MEMBER FURTHER UNDERSTAND AND ACCEPT YOUR FINANCIAL RESPONSIBILITY FOR ANY PORTION OF THE BILL NOT COVERED BY YOUR HEALTH INSURER OR HEALTH PLAN. SUBMISSION OF CHARGES DOES NOT WAIVE OUR RIGHT TO SEEK PAYMENT DIRECTLY FROM YOU.

B) Appointments Missed/Late Cancellation

You understand and agree that if you do not show for your appointment or you cancel your appointment with less than 24 hours notice, we may charge you a fee for a missed/late cancelled appointment.

C) Permission to Treat

You give permission to the Providers to medically care for you and your Covered Family Member. You may withdraw this consent at any time by no longer seeking Medical Services from Goals Healthcare. You understand and agree that as part of providing Medical Services to you, your Protected Health Information (PHI) (defined by HIPAA), including test results, may be released to an online personal health record and via communication with Goals Healthcare’s staff electronically (in accordance with our Notice of HIPAA Privacy Practices.

D) Termination of Services

You may terminate your use of the Medical Services at any time by not using the Medical Services any more. We may terminate your use of the Medical Services at any time in our reasonable discretion, for causes including but not limited to illegal conduct such as falsifying information to obtain controlled substances, abusive and threatening behavior, and continued refusal to pay for our services. We may terminate your use of the Medical Services by sending notice to you at the mail or email address you provided to us or by otherwise contacting you.

E) Mental Health Services Disclaimer

Mental health services involve discussing sensitive aspects of your life. You may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, or helplessness. If at any point you experience significant increased distress or have thoughts of harming yourself or others, you agree to notify your mental health provider so that an appropriate level of support can be provided.

F) Complementary and Alternative Services Disclaimer

Goals Healthcare may, from time to time, with your consent, offer Complementary or Alternative Services/Methods of Treatment (AS) connection with the Medical Services, which may include, but are not limited to: Herbal medicine, nutritional counseling, aesthetic services; elective cosmetic non-surgical procedures and non-surgical treatments and electrical stimulation. You must inform the Provider who is caring for you if you are or become pregnant, as this may affect your treatment protocol. If you seek AS treatment, you should also consult with a physician to be screened for any predispositions to injuries and risks in regard to any of the AS treatments, to address serious health concerns, and to avoid any contra-indications, including:

• Nutrition consultation services are not licensed by many states in the U.S. The methods of evaluation employed, which may include diet, supplementation, and assessment analysis, are not intended to diagnose disease.
• Herbs and nutritional supplements recommended are traditionally considered safe, although some may be toxic in large doses. You acknowledge that you understand that some herbs may be inappropriate during pregnancy. Some possible side effects of taking herbs include, but are not limited to, nausea, gas, diarrhea, and hives. You acknowledge that you understand that the herbs should be consumed according to the instructions provided verbally and in writing.
• Aesthetic services; elective cosmetic non-surgical procedures and non-surgical treatments involve many factors that determine the outcome. The exact same technical procedure or treatment performed on seven different patients will yield seven different outcomes. This is because each person is genetically different, heals differently, has different skin tone, bruises differently and procedures/treatments are customized to you as an individual. All aesthetic services; elective cosmetic non-surgical procedure and non-surgical treatment carries risks and side effects. Side effects and risks may include but are not limited to allergic reactions, bleeding, bruising, dizziness, drowsiness, headache, infection, itching, pain, paralysis, rash, redness, stiffness, swelling or weakness. The need to perform additional treatments/services, revisions or touch-ups is possible. Some patients may not experience results following their first visit. Any revision due to weight change over/under the baseline pre-procedure/pre-treatment weight constitutes a new procedure or treatment in the same anatomic location.

You acknowledge that you understand that while this section describes some of the major risks of AS treatment, it does not address all of them and other side effects and risks may occur. I have carefully read and understand the above. All questions I have about my expectations during and after my AS treatment have been answered to my satisfaction. I fully understand the risks and side effects associated with AS treatment. 

You understand that the AS modalities are not a substitute for conventional medical care. You will immediately notify your Provider of any unanticipated or unpleasant effects associated with any of your treatments.

G) Consent to Electronic Communications

You agree that Goals Healthcare may send the following to you by email or by posting them on our website: legal disclosures; these Medical Services Terms, Notice of HIPAA Privacy Policy; future changes to any of the above; and other notices, policies, communications or disclosures and information related to the Medical Services. You agree that Goals Healthcare may contact you via secure messaging, email, phone, text, or mail regarding the Medical Services. You consent to receive such communications electronically. You agree to update your contact information to ensure accuracy. If you later decide that you do not want to receive certain future communications electronically, please send an email to support@GoalsHealthcare.com or a letter to Goals Healthcare, 6 East 39th Street Suite 200, New York, NY 10016. Your withdrawal of consent will be effective within a reasonable time after we receive your withdrawal notice. Goals Healthcare will need to send you certain communications electronically regarding the Medical Services. You will not be able to opt out of those communications, for example communications regarding updates to these Medical Services Terms or information about billing. Your withdrawal of consent will not affect the legal validity or enforceability of the Medical Services Terms provided to and accepted by, you.

H) Disclaimers

TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, EXCEPT IN CASE OF NEGLIGENCE OR WILLFUL MISCONDUCT, WE AND OUR AFFILIATES, PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS WILL NOT BE RESPONSIBLE FOR ANY LOSS OR DAMAGE, INCLUDING PERSONAL INJURY OR DEATH, RESULTING FROM ANYONE’S USE OF OR INABILITY TO USE THE MEDICAL SERVICES.

The Medical Services are intended for use only within the United States and its territories. We make no representation that the Medical Services are appropriate, or are available for use outside the United States. Those who choose to access and use our Medical Services from outside the United States do so on their own initiative, at their own risk, and are responsible for compliance with applicable laws.

I) Liability Limitation

TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, IN NO EVENT WILL WE AND OUR AFFILIATES, PROVIDERS, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS BE LIABLE FOR ANY CONSEQUENTIAL, EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING WITHOUT LIMITATION THOSE RELATING TO LOST PROFITS OR THE COST OF SUBSTITUTE PRODUCTS OR SERVICES ARISING OUT OF OR IN CONNECTION WITH THE MEDICAL SERVICES OR FROM THE USE OF OR INABILITY TO USE THE MEDICAL SERVICES, WHETHER BASED ON CONTRACT, WARRANTY, PRODUCT LIABILITY, TORT OR OTHER LEGAL THEORY AND EVEN IF WE HAVE BEEN INFORMED OF THE POSSIBILITY OF SUCH DAMAGES. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SO THE ABOVE EXCLUSION MAY NOT APPLY TO YOU.

J) Affiliates and Partners

Goals Healthcare has Affiliates and Partners (AP) with select diagnostic labs, health systems and Telehealth companies to provide or facilitate Medical Services. For TeleHealth Services and Permission, as they relate to Medical Services provided with the AP please read and review carefully the terms for ELATION EMR, INC. (Elation Passport or Elation).

https://www.elationhealth.com/passport/terms-of-service/, and Elation Passport application located at https://apps.apple.com/us/app/elation-passport-for-patients/id1264836684 and https://www.app.elationpassport.com/passport/login/?next=/passport/, and PRACTICESUITE located at https://www.practicesuite.com/ and https://www.practicesuite.com/privacy-policy/.

K) Telehealth Services and Permission

Separate from its Partners, Goals Healthcare may provide certain Telehealth (defined below) services to you (the “Telehealth Services). You consent to receive emails or other electronic communications from Goals Healthcare pertaining to your care and your health, which may include Protected Health Information (PHI). You understand that virtual encounters via phone, email, video, or otherwise, could involve, and you hereby consent to the use of, automated tools for diagnosis, care, treatment or communication pertaining to healthcare matters. You also acknowledge that such virtual encounters may involve care by a variety of Providers, including Physicians, Registered Nurses, Physician Assistants, Nutritionists, Naturopathic Doctors, Therapists, and other support or medical personnel. You give permission to Goals Healthcare and the Telehealth Service Providers to record and process your personal details and medical data. You may withdraw these permissions at any time by no longer seeking Telehealth care from Goals Healthcare.

Telehealth is the delivery of healthcare services using technology when the healthcare provider and patient are not in the same physical location, and/or the virtual delivery of healthcare services, including by a medical provider or via digital or automated tools, including without limitation tools for medical or health-related diagnosis and treatment. The Telehealth Services may be used for diagnosis, treatment, care, follow-up and/or patient education, and may include, without limitation, the following: electronic transmission of patient medical records, medical images, and/or other patient data or information; synchronous (i.e., “real time”) and asynchronous (i.e., non-“real time”) interactions via audio, video, text, and/or data or other electronic communications; automated, electronic or digital tools or services for diagnosis, care, treatment and/or communication pertaining to healthcare or medical matters; and output, transmission or exchange of data from medical devices, sound and video files. Further, you understand that it may be possible that your condition cannot be treated via the Telehealth Services, or that information transmitted through the Telehealth Services may not be sufficient or of too poor of image quality, or insufficient information or data to allow for appropriate medical decision making. Accordingly, you may be required to seek additional in-person medical care, alternative healthcare or emergency services. If your health or medical problem or condition persists after use of Telehealth Services, you will immediately contact your medical services provider and seek appropriate additional in-person medical care or emergency care, as appropriate.

L) General Provisions

• These Medical Services Terms make up the entire agreement relating to your use of the Medical Services, and supersede all prior agreements relating to the subject matter hereof.
• We may change, suspend, or discontinue any of the Medical Services at any time. We will try to give you prior notice of any material changes to the Medical Services. We will not be liable to you or to any third party for any modification, suspension or discontinuance of the Medical Services.
• We may change, suspend, or discontinue any of our partnerships at any time. We will provide you with notices of such changes as applicable.
• You may not transfer any of your rights or obligations under these Medical Services Terms to anyone else without our consent. Goals Healthcare may assign our rights in connection with a merger, acquisition, or sale of assets, or by operation of law or otherwise.
• Even after termination, these Medical Services Terms will remain in effect such that all terms that by their nature may survive termination will survive such termination.

If you have any questions about these Medical Services Terms, please contact us at support@GoalsHealthcare.com.