Medical Services Arbitration Agreement

1. Agreement to Arbitrate

The undersigned agrees that any claim, dispute, or controversy arising out of or relating to medical services rendered, including claims for medical malpractice, shall be resolved by binding arbitration as provided by applicable law. This agreement applies to any claims against the healthcare provider, their partners, associates, employees, and agents.

2. Scope of Arbitration

• All claims, disputes, or controversies arising from diagnosis, treatment, or care.
• Applies to both present and future claims.
• Includes claims for wrongful death and loss of consortium.

3. Voluntary Nature of Agreement

Both parties understand that by agreeing to arbitration, they give up the right to a trial by jury or judge for any matter covered by this agreement.

4. Patient's Acknowledgement

The patient certifies that this agreement has been explained, any questions have been answered, and the patient voluntarily signs this agreement.

5. Revocation

Revocation of this agreement must be made in writing and applies only to services provided after the date of revocation.