Patient Treatment Contract

You agree with the following statements and agree to follow the requested procedures and policies governing your appointments and treatments at The Spero Clinic Integrated Health & Wellness Center (IH&WC). The Spero Clinic Integrated Health & Wellness Center (IH&WC) is committed to providing you with the best possible care and clinical outcome.

The staff at The Spero Clinic Integrated Health & Wellness Center (IH&WC)’s sole purpose is to remove interferences to the Central Nervous System. We do not claim to treat any specific condition, symptom, disease or syndrome.

You understand that while at The Spero Clinic Integrated Health & Wellness Center (IH&WC), you may receive care that is above industry standards in both frequency and cost, due to time constraints and the severity of your nerve interference.

The fees that you pay have been explained to you. You understand that you are paying for the staff’s expertise and for the time spent in treating me. The staff at The Spero Clinic Integrated Health & Wellness Center (IH&WC) does not guarantee any specific outcome and will not offer a refund based on treatment outcome under any circumstances.

If you choose to rent a Personal Recovery System (PRS) Unit, or a portable Frequency Specific Microcurrent unit, there will be a daily $37.50 fee. There is also a permanent $0.45 per minute charge while using the ARP Wave RX Unit. You understand these fees are not includes in you financial plan. Should you choose to purchase my own unit(s) the rental fees will no longer apply to you.

You understand that the focus is to ensure optimum environment for you to be successful in your journey to better health, The Spero Clinic Integrated Health & Wellness Center (IH&WC) uses a wide range of protocols including social behavior, dietary habits, honoring the schedule recommended to you, as well as keeping healthy boundaries with other patients and staff of the center.

You will maintain and be punctual for all your appointments and prescribed treatments without interrupting your scheduled care. Exceptions are made on a case-by-case basis with prior approval from Dr. van der Merwe. You also understand that any interruptions to your care can affect your progress. You the doctors and staff of The Spero Clinic Integrated Health & Wellness Center (IH&WC) blameless for any consequence due to interruptions in your plan.

You understand that if you are over 15 minutes late for your scheduled appointments, you will be charged in full for the appointment, and if you are 30 minutes late you will forfeit your appointment and need to reschedule for a later time. The Spero Clinic Integrated Health & Wellness Center (IH&WC) reserves the right to make exceptions upon one-hour prior notification.

You are responsible for making/maintaining your appointment times, and that they are set up on a first come basis, and at the discretion of the scheduler. The Spero Clinic Integrated Health & Wellness Center (IH&WC) will do their best to accommodate their patients need within their hours of operation.

You understand that practicing unhealthy habits (including but not limited to smoking, ingesting artificial sweeteners like aspartame often found in chewing gum, carbonated beverages and/or eating health foods) may alter the outcome of your treatments. This may cause your treatments to be more unpleasant and/or less effective.

You will participate in your prescribed treatments taking all recommended supplements while under care of The Spero Clinic Integrated Health & Wellness Center (IH&WC). Before you start taking recommended supplements from The Spero Clinic Integrated Health & Wellness Center (IH&WC), you will bring in all outside supplements for testing in combination with the new supplements from The Spero Clinic Integrated Health & Wellness Center (IH&WC). If you are taking prescribed, medications or other supplements that may interact with any supplements recommended by The Spero Clinic Integrated Health & Wellness Center (IH&WC)’s Doctors and/or staff members, you will address this with your physician.

You will do your utmost to maintain a positive attitude conducive to a beneficial outcome to your treatment and others around you.

You understand that a positive outcome is not guaranteed. Dr. van der Merwe and/or staff do not guarantee any particular outcome to any treatment. You understand that they will provide premium care and that healing happens from the inside out and not the outside in. Every individual is different and may respond differently even to identical care protocols.

You understand that the following provided by The Spero Clinic Integrated Health & Wellness Center (IH&WC) are all FDA approved:

In order to undergo any electronic modalities, you certify that you do not have a pacemaker/ICD (implanted cardiac device_, you are not pregnant, and you have not had blood clots in the past 12 months.

You understand that CRPS/RSD is specifically a progressive syndrome that may advance in an unpredictable manner. This may occur even while under the care of The Spero Clinic Integrated Health & Wellness Center (IH&WC). While Dr. van der Merwe and their staff’s treatments are considered non-invasive, you understand that any change to the nervous system may exacerbate your pain. You accept the risk and wish to continue with your treatment. You understand that the staff at The Spero Clinic Integrated Health & Wellness Center (IH&WC), is treating your nervous system only, not a specific condition.

You will not behave in a disruptive manner that may interfere with the clinic or with another patient’s care. You will not dispense any medications, prescribed or over-the-counter, to other patients while under the care of The Spero Clinic Integrated Health & Wellness Center (IH&WC), it’s Doctors and its staff. This includes legal and illegal substances.

You agree to follow all guidelines and be prepared for your treatments that require the intake of water and/or protein. 64oz of water are required per day to maintain proper hydration level to receive the best treatments possible. 32oz prior to treatment and 32oz after is necessary. Also, good sources and sufficient amounts of protein are required before and after treatments. If patient experiences detox effects such as a headache (or increase in one) or cold/flu like symptoms, please contact The Spero Clinic Integrated Health & Wellness Center (IH&WC) so we can assist you in reducing your symptoms.

You understand clearly that Technician’s phone numbers are to be contacted for medical reasons during the business hours primarily. If you have been instructed or there is immediate need you can text/call them after hours with understanding that your return text/call may take longer than usual due to the technician’s family needs or being out of phone range. You will receive a reply when they are able. You will keep texts/calls respectful, brief, and professional.

You will not communicate with the staff on any social media platform. (i.e.: Facebook, Instagram, Snapchat, etc. …)

You will not provide transportation to any other patient while under Dr. van der Merwe or their staff’s care. You also will not request or expect to be provided transportation for yourself or others while under Dr. van der Merwe or their staff’s care.

You understand that breaking this contract may result in termination of your care. At that time, a refund will be provided for any unused portion of your prepaid care plan. You understand that if you are a weekly paying patient, you will need to settle any outstanding balances before you are release from care.

If you terminate your care, any unused portion of your prepaid care plan will be refunded (prorated) to you.

Under any circumstances if you are in the building before/after hours or during lunch, you will not unlock the doors for anyone, for any reason due to HIPPA Compliance and security reasons. You will not ask anyone to open the door for you.

You will not bring any pets into the building unless they are certified service animals.

You understand that any activities you choose to participate in outside the office, including drug use, alcohol consumption, or any other activity that could potentially risk your own health and wellbeing are your choice alone. You understand that these activities may potentially negatively affect your health and/or endanger your life. You will not hold The Spero Clinic Integrated Health & Wellness Center (IH&WC) responsible for any negative effects nor consequences resulting from these choices.

Except as otherwise provided in this agreement, you agree to pay all charges related to your care or treatment in full without offset or deduction within thirty (30) days of the date of the invoice. If I should object to any portion of any invoice, you will deliver written notice to the payment address listed in the invoice within thirty (30) days of the date of the invoice, which notice will include a reasonably detailed description of each objectionable portion and the basis for each objection. All portions of any invoice for which you fail to so deliver such timely written notice shall be deemed accepted and all rights to object such portions shall be deemed forever waived. No term of this agreement may be modified, amended, or waived except by a written agreement signed by the party to be charged thereby and approved in advance by us. Each term of this agreement is severable from all other terms. Time is of the essence. This agreement shall be subject to and governed by the laws of the State of Arkansas. To the extent that there is an irreconcilable conflict between the terms of this agreement and any document executed or delivered in connection herewith, the terms of this agreement shall prevail. This agreement contains the entire agreement of the parties with respect to your care or treatment, and supersedes all prior agreements, contracts, and understandings of any kind with respect to your care or treatment, either oral or written. For purposes of this agreement, the terms “I”, “You” and “My” shall mean any of the undersigned, whether the undersigned is the patient or a guarantor of the obligations of the patient under this agreement, and the terms “we”, “us” and “our” shall mean The Spero Clinic Integrated Health & Wellness Center, LLC, and any other person or entity whom we designate to render services in connection with such care or treatment.

We are so excited to work with you. Thank you for your trust in choosing us.

You, the undersigned, hereby acknowledge that you have read, understood, and consent to all the terms of this agreement and that, if you are not the patient, hereby agree to be jointly and severally liable for, and absolutely, unconditionally, and irrevocably, guarantee the prompt and complete payment and performance of all the obligations of such patient under the terms of this agreement.

You accept financial responsibility.