Signed in as:
- FAQS & Care Instructions
- JAN MARINI MD SKIN CARE
- About Dr. Thomas-Goering
- Dr. Jennifer Vlog
- Dr. ReVivajennz Blog
- ReViva Diva Newsletter
- My Account
Signed in as:
Mediation and Dispute Resolution Agreement
Your care is important to us, and we feel it is vital to your treatment that we communicate openly and honestly.
As such, we request that you: Ask questions and participate in your care, be honest about your history, symptoms, and other important health information, prepare for and keep scheduled visits, and be respectful to our office staff and healthcare providers.
In exchange, we agree that we will: Explain diagnosis, treatment recommendations, and outcomes in an easy-to-understand way, listen to your questions and help you make decisions about your care, keep discussions and records private, and determine when a referral or termination of care is appropriate.
As a part of our emphasis on open communication, we ask our patients to sign this mediation agreement. While we do not anticipate any issues or concerns during the course of your treatment, if any arise, you (and/or your legal counsel) and your healthcare provider (and/or their legal counsel) agree to meet with a neutral mediator and work toward a solution. Whether or not a solution is found, mediation may postpone but does not remove or block your legal rights.
Importantly, you agree that any usage or inference to a "claim" will be understood and read as "potential claim" until the mediation is complete. This designation allows us to begin in a less formal manner that has been shown to expedite the resolution process. Your signature on this page confirms that should a concern arise in any aspect of the care provided by this office, staff, and affiliated healthcare professionals, you agree to mediate first before pursuing legal action.
Further, if after mediation, you still wish to pursue a court action relating to your care, your CONSENT ON YOUR MEDICAL RECORD confirms that you will use, as your expert witness(es) in your legal action, American Board of Medical Specialties board-certified medical witness(es) in the same specialty as Physician. Furthermore, you agree that the physicians who you select will be in good standing and adhere to all of the rules and guidelines of professional conduct of the American Board of Medical Specialties.
As consideration for this agreement, we agree that we will adhere to these same guidelines in selecting our expert witness(es) for any court action relating to your care.
By signing informed consent for procedure, I certify that I have read or had read to me the contents of this form. I understand the possible advantages that compliance with professional healthcare recommendations can provide as well as potential consequences of non-compliance. I attest that I have had the opportunity to ask questions and all of my questions have been answered to my satisfaction.
WHEN YOU SIGN CONSENT FOR ANY PROCEDURE YOU ARE AGREEING TO THE CONDITIONS STATED ABOVE.
DR. Jennifer Thomas-Goering
Copyright © 2023 DR. REVIVAJENNZ MEDICAL AESTHETICS - All Rights Reserved.
Powered by GoDaddy Website Builder
Introductory Special, All in one RF Intensive Microneedling, RF Fractional Skin Resurfacing, and RF Tighten & Contour full face $1500 (Regular $1900) plus free Jan Marini Post Treatment Kit while supplies last. The latest in RF (Radio frequency) Technology from Europe. 3 treatments in one device to tighten, smooth, lift, and resurface. Minimal downtime with maximal results.