Membership & Financial Agreement Consent Form

Purpose

This agreement outlines the terms of your membership and financial responsibilities when enrolling in MediDuce Wellness programs, including GLP-1 therapy, peptide therapy, telehealth services, and associated wellness programs.

By signing below, you agree to the financial terms, membership obligations, and consent to receive services.

Membership Terms

Membership begins upon completion of the intake form and first payment.

Membership includes access to telehealth consultations, medical supervision, treatment planning, and program resources.

Membership is personal and non-transferable.

Financial Responsibility

By ticking the box, you acknowledge and agree to the following:

Program Payments:

Monthly, Quarterly, Semi-Annual, or Annual plans must be paid in full according to your selected plan.

Payment is required prior to medication shipment or program activation.

Non-Refundable Fees:

The $50 consultation fee is non-refundable.

Medication orders, once processed or shipped, are non-refundable except where specified (e.g., 50% refund for unused annual plans).

Payment Methods:

Payments may be processed via credit card, ACH, or approved payment processors.

By providing your payment information, you authorize MediDuce Wellness to process recurring or one-time charges according to your plan.

Late or Failed Payments:

Late or declined payments may result in suspension of membership benefits or delay of medication shipment.

Re-activation may require additional fees or resubmission of payment information.

Acknowledgment of Terms

By ticking the box, you confirm that you:

Have reviewed your program type, selected plan, and payment schedule.

Understand all fees, payment obligations, and refund policies.

Agree to participate in the program under the terms outlined in this consent.

Authorize MediDuce Wellness to communicate billing information and program updates via email, SMS, and secure telehealth platforms.