Terms & Conditions: Informed Consent/Authorization
The following Statement of Client Responsibility; Informed Consent and Authorization sets forth the terms under which Dr. Rob’s Guided Meditation Services are supplying you access to in-person, telephonic and/or electronic consultation services with a Certified Meditation Teacher and other practitioners and your agreement to accept responsibility for your decision to seek these services thru Dr. Rob’s Guided Meditation Services.
In order to determine your compliance with these Terms, we reserve the right, but not the obligation, to monitor your usage of the services provided. Dr. Rob’s Guided Meditation Services may, in its sole discretion, refuse to provide access to the services due to actual or potential misuse of the site, these Services, or for noncompliance with these Terms.
To fill any service requests, you must verify that you have read and understand these conditions, including the Statement of Client Responsibility.
Statement of Client Responsibility
In submitting my health information in connection with my request for services, the following statements are true:
- I am an adult (at least 21 years of age).
- I am competent to use the services offered by Dr. Rob’s Guided Meditation Services, and I fully understand the nature of the services provided.
- I voluntarily choose to seek a meditation training session through Dr. Rob’s Guided Meditation Services.
- I recognize that the consultant reviewing my Health Information may or may not prescribe a meditation session based on my responses.
- I am aware that my failure to provide truthful, accurate and complete information to the consultant and any other providers could result in an inappropriate treatment decision that could be harmful to me or not be safe and effective. Therefore, I have responded to each question truthfully and accurately and have fully and completely disclosed any and all information concerning my health and medical history that could be relevant to my current condition and need for treatment and/or medication.
- I have been seen by a physician and have had a physical examination and/or medical history evaluation within one year of requesting services from Dr. Rob’s Guided Meditation Services. I agree to undergo a physical examination every year to ensure that my request for meditation training is appropriate, and to inform my personal physician about the products ordered or purchased, as applicable, thru Dr. Rob’s Guided Meditation Services.
- I will contact my physician if I have questions, difficulties or complications with recommended treatment(s).
- I will make the consultant aware of any changes to my medical condition in the event I return seeking services or products of any kind whatsoever.
- I understand that Dr. Rob’s Guided Meditation Services receives an electronic transmission of my request for a consultation and the reason for said consultation; directs my information to a consultant for his/her review and response in accordance with the consultant’s professional judgment as to my request.
- I understand that I am able to contact the consultant who reviews my information through the customer service number posted on the web site.
- I understand that I will be given the opportunity to ask the consultant any and all questions about any treatments/regimens that may have been recommended for me.
- I understand that the consultant is an independent, U.S. licensed practitioner; and not a physician.
- I understand that there are risks as well as benefits in undergoing any kind of meditation regimen or consultation service.
- If paying by credit or debit card, I am the owner of that credit or debit card or I am permitted by law to use such credit card.
Client Agreement and Acknowledgement:
As a customer or potential customer of the services provided by or through this website, I hereby understand, accept, and agree to the following:
In order to determine your compliance with these Terms, we reserve the right, but not the obligation, to monitor your access to and the use of the site and the Services. Dr. Rob’s Guided Meditation Services may, in its sole discretion, refuse to provide access to the site or services due to actual or potential misuse of the site, these Services, or for noncompliance with these Terms.
I am voluntarily providing my health and medical information for the purposes of obtaining services through Dr. Rob’s Guided Meditation Services.
I realize that the consultant will not conduct an in-person physical examination and will rely on the truthfulness and accuracy of the information I am providing through any forms distributed to me.
I am using this platform because I am seeking meditation guidance from a professional.
I acknowledge that Dr. Robert Galarowicz, Dr. Rob’s Guided Meditation Services as well as any of its employees do not practice medicine and are not healthcare service providers. I further acknowledge that Dr. Rob’s Guided Meditation Services cannot and does not direct, control or influence the opinions or decisions made by the consultant or other assigned employee with respect to my care.
I agree that any dispute arising out of or related to the provision of services by Dr. Rob’s Guided Meditation Services, by the consultant or other employee, or by their affiliates, employees, partners and agents, will be subject to mandatory mediation. Should mediation fail to resolve the dispute issue(s), said dispute shall be subject to final and binding arbitration and that all parties will agree to be bound by the arbitration, which will be enforceable in a court and that the parties waive any rights to bring suit in favor of agreeing to binding arbitration.
Any mediation, arbitration, administrative proceedings, or other proceedings shall be held in Bergen County, NJ, unless the parties agree otherwise, and shall be governed by the substantive law of the State of NJ without regard to conflicts of law.
I accept all risks, known and unknown, involved in, arising from or related to using the prescribed products or treatment. Subject to and without waiving any rights that may be conferred upon me under state or federal law, I will not seek indemnification and/or damages whatsoever of any kind from Dr. Rob’s Guided Meditation Services for negligent, reckless or intentional acts or omissions, and I hereby hold harmless Dr. Rob’s Guided Meditation Services from and against any and all liability relating to or arising out of my request for or receipt of treatment from Dr. Rob’s Guided Meditation Services.
I hereby release Dr. Rob’s Guided Meditation Services and the consultant and other employees from any and all claims that the consultant acted below the requisite standard of care on the basis that the consultant did not personally examine me.
I hereby acknowledge that all information and service provided by or through this web site and telephone service are provided “as is” without warranty of any kind, expressed or implied.
I acknowledge that any and all testimonials and/or reviews expressed by service provider represent only a cross section of the range of results that appear to be typical with these products and/or services. Results may vary depending upon client use and level of commitment.
If any provision of this agreement is held to be illegal, void or unenforceable, then this agreement may be modified or amended only to the extent necessary to enable the remaining provisions to be of force and effect to the maximum degree.
Client Authorization for Release of Individually Identifiable Health Information
In connection with providing certain individually identifiable health information to Dr. Rob’s Guided Meditation Services, I authorize the following:
I hereby authorize Dr. Rob’s Guided Meditation Services to use and disclose any of my health information, including all individually identifiable health information obtained through documents, forms and/or telephone consultations for the purpose of treatment, payment and health care operations. This authorization additionally includes, but is not limited to, any health information relating to HIV and other sexually transmitted diseases, mental health or disease, drug or alcohol treatments.
Dr. Rob’s Guided Meditation Services’ privacy notice provides more detailed information about our privacy policies, and you are encouraged to review it before agreeing to this authorization.
I declare under penalty of perjury that the foregoing is true and correct. My agreement to this statement constitutes my signature.