Patient Arbitration Agreement — v1

Article 1: Agreement to arbitrate

It is understood that any dispute as to medical malpractice, that is as to whether any medical services rendered under this contract were unnecessary or unauthorized or were improperly, negligently or incompetently rendered, will be determined by submission to arbitration as provided by California law, and not by a lawsuit or resort to court process except as California law provides for judicial review of arbitration proceedings. Both parties to this contract, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.

Article 2: Parties and covered disputes

This agreement is between the patient and Corinne Aesthetics PC. It applies mutually to medical-malpractice disputes about medical services provided under this agreement by the Practice and its treating licensed healthcare providers, to the extent permitted by law. It does not automatically require arbitration of unrelated marketing, sales, billing, employment or other nonmedical disputes with Corinne Aesthetics LLC, SalesMD or other entities.

Related wrongful-death or other claims by representatives or heirs are covered only to the extent applicable law permits. This agreement does not create authority for a signer to bind another person or waive rights that cannot lawfully be waived. A representative must identify their capacity and have authority to sign.

Article 3: Neutral arbitrator, procedure and costs

A party seeking arbitration must provide written notice to the other party describing the dispute and requested relief. Notices to Corinne Aesthetics PC may be sent to the Main Office at 123 Hodencamp Rd, Suite 106, Thousand Oaks, CA 91360, or [email protected]. Keep a copy and proof of delivery.

The parties will seek to agree on an independent, neutral arbitrator. If they cannot agree, either party may request appointment through the procedures available under California law. Arbitration will take place in Ventura County, California, unless the parties agree to another location or a remote hearing.

If the American Arbitration Association administers the dispute, its rules appropriate to the dispute and applicable due-process standards govern, subject to controlling law. This agreement does not require Commercial Rules where another ruleset is required. Administration remains subject to the provider’s acceptance of the agreement.

Fees and arbitrator compensation must be allocated under applicable law and any applicable arbitration-provider rules. This agreement does not automatically require the patient to pay half of the arbitrator’s fees. Any required consumer fee limits or fee-waiver protections apply. Attorney fees and other costs may be awarded only as permitted by applicable law.

The parties may obtain legal representation and the information needed to present their claims and defenses, subject to applicable law. The arbitrator may award remedies available under applicable law. This agreement changes the dispute-resolution forum; it does not release the Practice from liability.

Article 4: Preserved rights and court involvement

Applicable legal filing deadlines remain in effect. This agreement does not create an additional forfeiture of claims for failing to pursue them with an undefined degree of diligence.

Nothing prevents a complaint to a licensing board or government agency, or a court proceeding that applicable law permits, including review of agreement formation or enforcement, appointment of an arbitrator, available provisional relief, or confirmation or challenge of an award. Court review of an arbitration award is limited by applicable law; arbitration does not provide an automatic right to retry the dispute before a jury.

Article 5: Thirty-day written rescission

The patient may rescind this arbitration agreement by written notice within 30 days of signature. Send the notice to Corinne Aesthetics PC, Main Office, at 123 Hodencamp Rd, Suite 106, Thousand Oaks, CA 91360, or [email protected]. State that you are rescinding the arbitration agreement and identify the patient and signature date. Keep a copy and proof of delivery.

A guardian or conservator may give written rescission notice if the patient is incapacitated or a minor, as provided by California Code of Civil Procedure section 1295. Unless timely rescinded, the agreement governs subsequent open-book account transactions for the medical services for which it was signed, as provided by that section.

Rescinding arbitration does not withdraw treatment consent, cancel appointments or eliminate payment obligations for services provided. It changes the agreement to arbitrate covered disputes.

Article 6: Effective date and copies

This agreement applies from the date it is signed. It does not automatically cover services provided before that date. Any proposed retroactive agreement requires a separate, clearly presented choice and review.

The patient must receive the agreement and required notices before signing and may obtain a copy of the signed agreement. If a provision is unenforceable, the remaining provisions apply only to the extent permitted by law; this does not authorize rewriting the agreement to impose a materially different bargain.

Signing through the Mangomint intake form

This webpage provides the agreement for review and does not collect a signature. Signing takes place in the Mangomint patient intake form, where this agreement and its required notices must be provided before signing. Viewing this page alone does not mean you agree to arbitration. You may request a copy from the Main Office at (805) 765-3539 or [email protected].

Notice presented before signing in Mangomint

NOTICE: BY SIGNING THIS CONTRACT YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP YOUR RIGHT TO A JURY OR COURT TRIAL. SEE ARTICLE 1 OF THIS CONTRACT.