SERVICE AGREEMENT
Date: _________________________
| Parties: |
Choice Self-Directed Healthcare
885 Main Street Winnipeg , MB R2W 3P2
(“Choice”) |
- and -
| Name: |
___________________________________ |
| Address: |
___________________________________ |
| Phone: |
___________________________________ |
| Email: |
___________________________________ |
(the “Client”)
WHEREAS: A. The Client wishes to obtain medical treatment and/or surgical procedures in Cuba as specifically set out in a medical treatment plan recommended to the Client by Cubanacan Turismo Y Salud, S.A., of Havana, Cuba (the “Cuban Medical Authority”) and attached as Schedule “A” (the “Medical Treatment Plan”);
B. Choice has and/or will continue to assist the Client to: a) consult with medical doctors and surgeons in Cuba ;
b) arrange, pay for, attend and undergo medical treatment and/or surgical procedures in Cuba ; and
c) make travel arrangements to, from and within Cuba , as specifically set out in Schedule “B” (the “Travel Plan”);
(together, the “Services”)
C. The parties wish to confirm the terms and conditions upon which Choice will provide the Services to the Client.
NOW THEREFORE THE PARTIES AGREE AS FOLLOWS:
1. ARRANGEMENTS FOR MEDICAL TREATMENT The Client hereby authorises, appoints and instructs Choice as his/her agent for the purpose of contracting with the Cuban Medical Authority to provide medical treatment and/or surgical procedures to the Client as set out in the Medical Treatment Plan. Choice agrees to act as the Client's agent in this limited capacity and will make all necessary arrangements as instructed by the Client. The Client acknowledges having reviewed and approved the Medical Treatment Plan in detail, and having obtained all medical and other advice necessary or beneficial in doing so. Choice makes no recommendations, endorsements, representations or warranties whatsoever in respect of the Medical Treatment Plan, the Cuban Medical Authority.
2. TRAVEL ARRANGEMENTS The Client hereby approves the Travel Plan and authorizes Choice to make all necessary bookings and arrangements in order to implement same. Choice makes no recommendations, endorsements, representations or warranties whatsoever in respect of any aspect of the Travel Plan.
3. PAYMENT ARRANGEMENTS The Client will pay to Choice the price in full as set out in each of the Medical Treatment Plan and the Travel Plan, prior to departing from Canada in accordance with the Travel Plan. These payments are non-refundable except to the extent (if any) that Choice may actually receive a refund of amounts paid to third parties on behalf of the Client including the Cuban Medical Authority, airlines, hotels and the like.
4. EXTRA CHARGES AND CONTINGENCY FUND The Client will pay all charges, costs and expenses incurred by or on behalf of the Client that are not specifically included in the Medical Treatment Plan or the Travel Plan (“Extra Charges”). By way of example, Extra Charges may include, but are not limited to, extended accommodation, additional travel activities and additional medical and/or surgical services provided by the Cuban Medical Authority. The Client hereby indemnifies Choice in respect of all Extra Charges and agrees to pay to Choice a contingency fund equal to 10% of the combined price of the Medical Treatment Plan and the Travel Plan for the purpose of paying or reimbursing any bona fide Extra Charges. Choice will reimburse the remaining balance of the contingency fund to the Client 30 days after the Client returns to Canada .
5. SUBSTITUTE DECISION MAKING The Client acknowledges that additional medical and/or surgical services may be necessary in the course of or subsequent to the completion of the Medical Treatment Plan. It is the mutual expectation of the parties that, in the event that the Client is for any reason (in the opinion of the attending physician provided by the Cuban Medical Authority) incapable of making his/her own medical treatment decisions, and if the Client is not accompanied by a substitute decision-maker authorised to make such decisions on behalf of the Client, the said physician will make such decisions as he/she see fit. However, the parties expressly agree and understand that the Client is solely responsible for arranging substitute decision-making and that Choice will not be responsible to make any medical treatment decisions whatsoever.
6. TRAVEL INSURANCE The Client will obtain travel documentation required by the Travel Plan and travel insurance in an amount of no less than $1,000,000 and provide confirmation of same to Choice prior to departure from Canada .
7. LIABILITY WAIVER The Client will, as a condition of this Agreement, execute a Waiver and Indemnity in favour of Choice in the form attached as Schedule “C”. The Client agrees and acknowledges that he/she is undertaking the Medical Treatment Plan and the Travel Plan at his/her own risk, and further that Choice is not responsible or liable for any treatment, opinions or other services and procedures rendered by any doctor, hospital or medical professional in Canada or outside of Canada. Choice is further not liable for any malpractice, injuries or consequences that may arise directly, or indirectly, from any advice, treatment, or other medical services rendered to the Client.
8. CONFIDENTIAL INFORMATION
Except as may be expressly authorized by the Client, Choice agrees not to disclose, divulge or otherwise make available to any person any confidential information of any kind relating to the Client. Without limiting the generality of the foregoing, the confidential information includes information concerning any medical history, conditions or the financial position of the Client. Choice's Privacy Policy shall govern this Agreement and is available at www.choice.ca , www.choicemedicalservices.com , or upon request.
GENERAL CONTRACTUAL MATTERS
9. Any amendment to this Agreement requires the unanimous written consent of the parties hereto.
10. Whether or not expressly stipulated herein, every notice or other communication shall be in writing and delivered personally to the recipient at the address set out in the preamble to this Agreement.
11. It is agreed between the parties hereto that neither party shall be held responsible for damages caused by delay or failure to perform its undertakings under the terms of this Agreement when the delay or failure is due to fires, strikes, floods, acts of God, war, war-like acts including (without limitation) terrorist acts, other catastrophic events, lawful acts of public authorities, or delays or defaults caused by common carriers, which cannot reasonably be foreseen or provided against.
12. U nless expressed otherwise herein, all funds referred to in this Agreement shall be a reference to funds in Canadian dollars.
13. The Preamble hereto is incorporated herein and shall form an integral part hereof.
14. Each party hereto covenants and agrees to do all things and execute and deliver all such documents, instruments and assurances as may be required in order to effectuate this Agreement.
15. This Agreement shall be construed and enforced in accordance with the laws of Manitoba and the laws of Canada applicable herein.
16. In the event that any provision of this Agreement shall be invalid, illegal or unenforceable it shall not affect the validity, legality or enforceability of any other provision of this Agreement.
17. This Agreement constitutes the entire agreement between the parties hereto and contains all the representations, undertakings, and agreements of the respective parties. There are no verbal representations, undertakings or agreements of any kind between the parties respecting the subject matter hereof except those contained herein.
18. The parties hereto acknowledge that each of them have had an opportunity to obtain independent legal advice prior to the execution of this Agreement for the purposes of reviewing same.
19. For the convenience of the parties hereto, this Agreement may be executed in any number of counterparts with the same effect as if all parties had signed the same document. All counterparts shall be construed together, and shall constitute one and the same Agreement binding on the parties, notwithstanding that all parties are not signatory to the same counterpart.
20. This Agreement shall enure to the benefit of and be binding upon the parties hereto and their respective successors and assigns.
IN WITNESS WHEREOF the parties have affixed their hands and seals on the date and year first above written.
Sullivan Healthcare Limited o/a
CHOICE SELF-DIRECTED HEALTHCARE
Per: ___________________________________
Authorized Signing Officer
| ___________________________________ |
Client's Signature Name: |
___________________________________
Witness |
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| Name: ______________________ |
Address:______________________
_____________________________ |
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