Claudia V. Perdei, MD, PA

I have engaged Claudia V. Perdei, MD, PA and its physicians Claudia V. Perdei, MD and Andrew R. Clementz, MD to provide non-covered primary care services and other amenities and benefits to me for a period of one year beginning on September 5, 2023. I understand that a yearly membership fee is assessed to pay for these non-covered services, amenities and benefits. As used in this Agreement, the term “Service Year” refers to the 1-year period beginning on the date above, as well as every 1-year period after thereafter.

This Agreement is for non-covered, non-clinical amenities and benefits as described in the Highlights & Details document. I have read and understand this Agreement as well as the Highlights & Details and Frequently Asked Questions documents that are considered a part of this Agreement. I understand that this Agreement can be terminated upon 30 days written notice and that, if the Agreement is terminated, I may receive a prorated refund of the annual fee I paid, based on the number of days that have elapsed in the Service Year (which will be determined by the Company on a case-by-case basis). Such refund will be paid to me within 30 days after termination. Unless the Agreement is terminated as provided in the first paragraph of this Agreement above, it will automatically renew for subsequent Service Years under the same payment terms unless I notify the Company otherwise (or the Company notifies me) within 30 days prior to the next payment due date.

I understand the full annual fee will be charged upon receipt of this form and the full annual fee will be charged automatically at 12-month intervals, continually (beginning September 5, 2024) while this Agreement remains in effect.