Here's to Your Health
An 18-Month Medical Appointment Package
Agreement and Release of Liability
By signing this agreement, I, the undersigned, acknowledge that I have read, understood, and agree to the following terms:
1. Nature of Services
I understand that Dr. Astrid Pujari and her professional health coaching practice, Astrid Pujari, MD, PS (collectively referred to in this agreement as “Dr. Pujari”), are providing consultative and educational services only.
I understand that Dr. Pujari is not acting as my primary care physician and does not provide emergency, urgent, or on-call medical care.
I agree to maintain an ongoing relationship with a primary care physician licensed in my state of residence for my general and emergency medical needs.
In the event of an emergency, I agree to call 911 or proceed to the nearest emergency department.
2. Fees and Payment Terms
The fee for the Here’s to Your Health 18-month package is $3,996.00, payable:
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in full at registration, or
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in 18 monthly installments of $222.00 each
If choosing the monthly option, the first payment of $222.00 is due at registration. Subsequent payments of $222.00 will automatically be charged to the card on file on the first day of each month for 17 additional months, until the total payment obligation of $3,996.00 has been satisfied.
To finalize registration, I must submit:
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a signed copy of this agreement
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a valid credit card authorization
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any required intake forms or relevant health documentation requested by Dr. Pujari’s office prior to my first appointment
If paying monthly, I authorize automatic recurring billing and understand that failure of payment may result in suspension of services until my account is current.
*Please initial below to confirm that you understand and agree to the fees and payment terms.
3. Appointment Scheduling and Completion Policy
The package includes twelve (12) one-hour appointments, to be used within 18 months of signing this agreement.
I understand that:
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I am responsible for scheduling and attending all appointments within the 18-month period.
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Any appointments not completed within this period are forfeited without refund.
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No extensions, refunds, or credits will be granted for missed or unused sessions, regardless of reason.
I may gift up to two (2) of my twelve appointments to another individual, provided those sessions are also used within the same 18-month term. If the recipient fails to schedule or attend the gifted appointment, it is forfeited without refund.
4. Package Inclusions
This package includes:
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Twelve (12) one-hour individualized integrative health appointments
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A 5% discount on supplement purchases made through Dr. Pujari’s office (subject to applicable policies or product availability)
5. Appointment Location and Format
Appointments may be conducted virtually (via secure telehealth) or in person at:
20006 Cedar Valley Road, Suite 203
Lynnwood, WA 98036
In-person visits are available only at this location.
If Dr. Pujari relocates her office during the 18-month program, in-person appointments will simply take place at her new location, and participants will be notified ahead of time.
6. Limitation of Liability and Disclaimer
I acknowledge and agree that:
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Dr. Pujari and her employees, contractors, and affiliates make no guarantees or warranties, express or implied, regarding outcomes from participation in this program.
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All information provided through consultations, written materials, or the website is for educational and informational purposes only.
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I am solely responsible for my decisions and actions related to any recommendations or information provided.
I agree to consult my primary care provider before implementing any new health regimen, making medication changes, or acting on any recommendations received.
I will not delay, disregard, or substitute professional medical advice based on any information obtained from Dr. Pujari.
I agree to hold harmless and indemnify Dr. Pujari, her affiliates, and staff from any and all claims, damages, or liabilities arising from or related to my participation in this program.
7. Insurance and Reimbursement
Dr. Pujari does not bill insurance for services.
Once my package is paid in full, I may request a super bill for potential reimbursement under the following conditions:
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I reside in Washington State
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I understand that insurance reimbursement is not guaranteed
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I understand that submitting a claim, verifying coverage, and communicating with my insurance company are my sole responsibility.
8. Refund and Transfer Policy
This Here's to Your Health medical coaching package is non-refundable and non-transferable in full.
However, the participant may gift up to two (2) individual appointments from the package to another person, provided that:
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The recipient completes their appointment(s) within the same 18-month term of this agreement
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All other package terms and conditions remain unchanged
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The remaining ten (10) appointments are to be used solely by the participant.
Unused or uncompleted gifted appointments are forfeited without refund.
9. Entire Agreement and Governing Law
This Agreement constitutes the entire understanding between the parties and supersedes any prior representations, written or oral. Any modifications must be in writing and signed by both parties.
This Agreement shall be governed by and construed in accordance with the laws of the State of Washington.