Please complete this consent form before proceeding with payment. Thank you.
Membership program contract details between YOU and ELEVATED HEALTH INC.
CANCELLATION OF MEMBERSHIP PROGRAM
You may cancel this Membership Agreement at any time with THREE MONTHS WIRTTEN NOTICE. Elevated Health inc. will often provide supplements, testing, and consultations in advance of receiving Membership Fee payments. If you wish to cancel your membership at any time when we have provided a significant amount of services in advance of payment, we reserve the right to ask for additional Participant Fee payments to settle your account at closing.
The monthly Participant Fee and products are subject to change on THREE MONTHS notice.
SUPPLEMENT PICKUP & SHIPPING
Supplements can be picked up at Elevated Health Clinic at no cost. If you require your supplements to be mailed to you standard shipping charges will apply.
LATE CANCELLATION POLICY
All appointments are subject to a $50 fee to be collected before your next appointment in the event that you do not provide us with a minimum of 24 hour notice to reschedule or cancel an appointment.
HEALTH INSURANCE & MEDICAL EXPENSE ELIGIBLITY
A portion of the Elevate Membership Program Fee can be reimbursed to you if you have employee health benefits, health insurance, or an employer provided health spending account. Elevated Health inc. is able to provide, upon request, the appropriate receipts to facilitate an insurance claim as services are provided.
Due to the variety of terms and conditions that employee health benefit, health insurance, and health spending account plans have regarding amounts eligible for reimbursement, Elevated Health inc. cannot guarantee that these providers will approve and reimburse your claims.
The Canadian Revenue Agency will recognize only the non-supplement related portion of the Participant Fee as eligible medical expenses. Receipts in the appropriate amount are available on request.
PROGRAM PAYMENT
In consideration of Elevated Health inc. providing the membership program of my choice and its products and services to me, I agree to pay the associated Membership Program Fee to participate in the chosen program on an ongoing monthly basis. If I fail to make a payment, my account will be suspended until the amount owing is paid.
