Consent, Disclaimer
& Informed Agreement
This agreement outlines the terms, risks, privacy practices, and expectations for services provided by Vitalia Concierge. Please read carefully. By signing below, you are agreeing to receive services and accept the terms set forth.
1. Nature of Services
Vitalia Concierge provides a range of non-emergency, in-home wellness and nursing services, including but not limited to:
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Nursing assessments and care
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Post-operative wound management
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Wellness and hydration infusions
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Prescription support for uncomplicated symptoms
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Elder care and assistance with activities of daily living (ADLs)
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Respite care, companionship, and case management
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Referrals and collaboration with primary care providers or specialists when needed
These services are provided by licensed professionals working within their legal scope of practice under Massachusetts law. Our medical oversight is provided by a nurse practitioner serving in a consultant role.
2. Consent to Care
By signing this agreement, you acknowledge and agree that:
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You are voluntarily receiving care from Vitalia Concierge.
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Our services complement but do not replace urgent care, emergency care, or primary medical care.
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You may be advised to seek further or emergency treatment elsewhere, and doing so does not waive payment for services already rendered.
3. Informed Consent, Assumption of Risk & Limitation of Liability
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You understand that no service guarantees a diagnosis, treatment, or specific outcome.
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All care is based on information you provide. Inaccurate or incomplete information may impact care quality.
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Vitalia Concierge assumes no liability for outcomes resulting from delays in seeking higher-level care, failure to follow recommendations, or withheld information.
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You agree to release, indemnify, and hold harmless Vitalia Concierge, its providers, owners, and affiliates from any claims or liability related to services rendered, except in cases of gross negligence or willful misconduct.
4. Payment Terms
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All fees are due in full at the time of service and are non-refundable, regardless of whether further treatment is needed elsewhere or no treatment is provided during the visit.
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You are paying for the provider’s time, travel, clinical judgment, and expertise—not a guaranteed result or intervention.
5. Disclaimer of Medical Guarantees
By booking services, you:
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Acknowledge that you are voluntarily participating in treatments and accept responsibility for any risks or side effects.
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Understand that individual responses vary.
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Agree to disclose any allergies, medical sensitivities, or relevant medical history before care begins.
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Acknowledge that services provided are designed to support, not replace, any existing treatment plans or medications.
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Understand that we are committed to collaborating with your existing healthcare providers when appropriate, and you are encouraged to speak with your primary provider before starting new treatments.
6. HIPAA Compliance & Privacy
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Your personal health information is protected in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
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We do not share your health information without your consent, unless legally required or necessary for treatment, billing, or operational purposes.
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Our Notice of Privacy Practices is available upon request and outlines how we handle your health data.
7. Electronic Communication & Signature Consent
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You consent to receive services or communication (when appropriate) via phone, text, or video consult.
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You authorize the use of your electronic signature as legally valid and binding.
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You acknowledge that this consent is equivalent to a physical signature under applicable law.
Acknowledgment & Agreement
By signing below, you confirm that you
Have read and understand this consent, disclaimer, and agreement.
Have had the opportunity to ask questions.
Voluntarily consent to receive services under the terms outlined above.