Patient Service Agreement
This Patient Service Agreement ("Agreement") is between Phleb-Finders, LLC ("Phleb-Finders") and the undersigned patient ("Patient"). This Agreement is effective as of the date signed below ("Effective Date").
Services Provided: Phleb-Finders will arrange for a qualified phlebotomist to perform a one-time blood draw at the Patient's location.
Fees and Payment:
If the blood draw is scheduled to occur within three (3) days of the request, the fee is $125 per person draw plus mileage for the contracted phlebotomist. Mileage will be coordinated ahead of time and approved before the blood draw takes place.
If the blood draw is scheduled with at least three (3) days' notice, the fee is $95 per person.
If more than one blood draw is required at the same location, mileage will only be billed once.
Payment must be made in full prior to the scheduled appointment and before the blood draw takes place.
Specimen Handling: Phleb-Finders ensures proper collection and transportation of the specimen to the designated laboratory. Any issues with the specimen must be reported to Phleb-Finders within five (5) days of the appointment.
Patient Responsibilities:
The Patient must have the required blood draw kit on hand at the time of the appointment.
All necessary documentation, instructions, and requirements for the blood draw must be provided and adhered to before the phlebotomist arrives.
Confidentiality: Patient information and clinical records will be kept confidential and used solely for the purpose of providing the agreed services.
Independent Contractors: The phlebotomists are independent contractors and not employees of Phleb-Finders.
Liability: Phleb-Finders is not responsible for any indirect or consequential damages arising from the services provided.
Termination: Either party may cancel this Agreement with written notice prior to the scheduled appointment.
Dispute Resolution: Any disputes will be resolved through binding arbitration in Peoria, AZ, under the rules of the American Arbitration Association.
Governing Law: This Agreement is governed by the laws of the Commonwealth of Arizona.