Above named patient or responsible party enters into a contract with Grassroots
Healthcare, PLLC to provide primary health care services and enhanced access (at a reduced rate) for a monthly member’s fee. Monthly fees are as follows with automatic
payment deduction on the FIRST of every month:
0-17 years $25/mo*
18-44 years $50/mo
45-64 years $75/mo
65 and older $100/mo
*Must have at least one full paying adult membership with credit card on file
See Attachment A for complete list of Direct Care membership benefits, services covered and reduced fee schedules. See Attachment B for services not covered by subscription fee. An initial registration fee of $75 applies.
Patient must have valid credit card to become a member. Patient may choose to cancel at any time and pay the $100 cancellation fee. Cancellation will be effective on the first day of the following month. Should the patient decide to reinstate his/her membership, he/she will be required to pay the initial registration fee again, as well as the lapsed months if within the same contract year.
This contract will guarantee you healthcare for a period of 12 months from the time of signing. Our system will automatically continue your membership and fees following the 12 month period on a month to month basis unless we receive notification of your cancellation.
If you fall behind in your monthly payments, all services will be halted. This means that no office visits, lab draws, services or procedures will be conducted until you are current with payment. If you fall behind payment more than 2 months your contract will be terminated and you will be charged a $100 cancellation fee. If you are terminated for breach of contract, you may continue your care with Grassroots on a pay-per-visit basis but you lose the membership contract pricing and perks.
Grassroots Healthcare Direct Care Contract – Attachment A
Office Visits–there is no charge for visits – this includes but is not limited to office visits, televisits, phone calls or emails.
Discounted Minor Surgical Fees. There will be a $25 charge for each minor surgical procedure if your procedure requires stitches there will be an additional $25 to help offset the cost of supplies. FEES SUBJECT TO CHANGE
Free Yearly Physical Examination (lab fees are discounted, but not free).
Direct Phone Access to a provider 24/7 for emergencies/urgent care only.
Free Blood Draws.
Discounted Lab Fees.
Expedited Appointments–depending on urgency we are able to book same day or next day appointments
Prices subject to change depending on supply charges.
*Perhaps the greatest benefit of membership may be the potential to avoid costly emergency room visits through enhanced access. One call to Grassroots
Healthcare may save you a lot of money. A single emergency room visit could cost more than a years membership fee.
Services Provided in Our Clinic
Acute Illness :
Colds, Headaches, Abdominal Complaints, Rashes, Urine Infections
Chronic Illness :
Hypertension, High Cholesterol, Diabetes, Asthma, Arthritis
Physical/Wellness Exams :
Yearly Wellness Exams, Sports Exams, Weight Management
Minor Surgeries/Procedures :
Moles, Skin Cancer, Skin Tags, Boils, Cysts, Warts, Lipomas, Ingrown
Toenails, Ear Irrigation, Cortisone Injections, IV infusions
Sprains and Strains
Lacerations and Wounds
Wholesale Lab Fees and Wholesale Medications
Grassroots Healthcare Direct Care Contract-Attachment B
Services not covered by monthly membership fee include:
All Aesthetic procedures
Lab fees , Radiology fees , Specialist Visits , Hospitalizations OR Emergency room/
urgent care visits
ANY MISUSE OF THE CONTRACT (EXCESSIVE APPOINTMENTS OR NON URGENT
TEXTING ETC )WILL RESULT IN IMMEDIATE TERMINATION OF MEMBERSHIP.