Terms of service

Reliable Urology Care Customer Agreement and Information 

Customer Agreement: 

  • Terms of Agreement and Medical Consent.  Customer acknowledges receipt of all equipment and/or supplies listed on this delivery ticket, that he or she is under the care of his or her attending physician, and that Reliable Respiratory / Reliable Urology Care shall not be liable for any act or omission undertaken at the direction or under the instruction of said physician. 
  • Medical Information Authorization.  Customer authorizes any holder of medical information relating to said Customer to release to Reliable Respiratory / Reliable Urology Care any record pertaining to his or her medical history, services rendered, or treatment.  Customer authorizes Reliable Respiratory / Reliable Urology Care to release Customer’s medical information to appropriate accreditation and insurance company personnel and other health care related organizations. 
  • Assignment of Insurance Benefits.  Customer authorizes any and all Medicare or other insurance benefits to be paid directly to Reliable Respiratory / Reliable Urology Care for any services or equipment furnished to Customer by Reliable Respiratory / Reliable Urology Care. 
  • Acknowledgments: 
    • Customer understands that certain equipment, supplies, and/or services may not be covered by his or her insurance company and may also be subject to a copay and/or a deductible.  Any amounts not paid or covered by Customer’s insurance company will become Customer’s personal financial responsibility, for which Reliable Respiratory / Reliable Urology Care may charge Customer’s credit card on file. 
    • The individual accepting delivery and/or any other person responsible for using or caring for any equipment and/or supplies has been thoroughly trained on the use, care and safety of the above equipment and/or supplies and has adequately re-demonstrated all procedures.  Reliable Respiratory / Reliable Urology Care shall not be liable for any acts or omissions of any Customer or other person in relation to the use of such equipment and/or supplies which violate these procedures. 
    • Customer acknowledges receipt of the Client Bill of Rights and Responsibilities, Notice of Privacy Practices, Equipment Owner’s Manual, and information regarding Medicare covered items under warranty. 
  • Default.  In the event that any invoice which is the financial responsibility of the Customer is not paid for a period of fourteen (14) days or more after becoming due, Reliable Respiratory / Reliable Urology Care may take action against the Customer to collect any amounts owed to it, including charging Customer’s credit card on file, without any further notice to Customer.  Reliable Respiratory / Reliable Urology Care may require Customer to return any equipment in its possession until such outstanding amounts are paid in full. 
  • Governing Law.  Any agreement between Reliable Respiratory / Reliable Urology Care and Customer shall be governed by the laws of the Commonwealth of Massachusetts, without application of its conflicts of laws principles. 
  • Severability.  Should any part of these Terms and Conditions, for any reason, be declared invalid or unenforceable, the invalidity or unenforceability of the particular provision shall not affect the other provisions, and these Terms and Conditions shall be construed in all respects as if such invalid or unenforceable provision had not been contained herein. 
  • I give permission for Reliable Respiratory, Inc. to use email in order to communicate with all relevant people involved in my diagnosis and treatment.