By requesting a physician referral from the Resource Partners Referral Network (RPRN), I accept and understand the following:

I understand that it is my responsibility to comply with RPRN protocols that include an annual physical examination along with possible laboratory tests to ensure that I have no underlying medical conditions that might make any therapies (including prescription drugs) inappropriate for my condition. Additionally, I agree to truthfully provide a complete and accurate medical history. I agree to allow RPRN physicians and physician medical staff to review all the information and requests I have provided in writing, or verbally to accurately evaluate me as a potential patient, and in the process of establishing/maintaining my medical records. I also fully understand that if I have failed in any way to furnish my RPRN physician with my complete and accurate medical history, or become aware of any changes in the future of which I have not notified my RPRN physician , that proper care can not be diagnosed and that I cannot expect to hold the RPRN physician responsible for any adverse effects I may suffer.

I agree to schedule my physical examination with my RPRN selected physician no later than 1 - 3 business days after receiving my RPRN exam notification.

Patient will pay provider at a rate of $85.00 per encounter/office visit for health assessment services. After reviewing my medical history and/or during the physical examination, I understand there is the possibility that my RPRN physician may determine that additional laboratory testing and referrals are necessary. All other associated costs pertaining to exam is also the responsibility of the patient (ie. labs, xrays).

I understand it is my responsibility to immediately notify any other physician whose present care I am also under about my consultation from RPRN , (including any prescriptions that may be prescribed) so that they, too, may advise me concerning any potential conflicts in care and so that all my healthcare providers may be able to consult regarding my care. If I receive the care of a new healthcare provider in the future, I agree to immediately notify that healthcare provider, as well.

I understand that if treatment is prescribed, it is possible that I may suffer potential adverse effects (side effects) and that no physician, nurse, pharmacist or medical staff personnel can guarantee clinical benefit from prescribed treatments

I understand and acknowledge that all prescription medications can cause serious adverse events (side effects). I understand that during my physician consultation, my RPRN physician will attempt to communicate all potential side effects of a medication that is being prescribed, and that additional prescribing information will accompany my prescription(s), but it is not possible for all the potential side effect(s) of a medication to be known. I understand that the potential side effects and complications that are communicated to me are highly predicated upon the information I provide to the RPRN referred physician both verbally and in the medical record and history submitted to the attending physician.

Physician Terms of use.

As a member physician of the Resource Partners Referral Network I understand and accept the following:

I agree to a face-to-face consultation with all RPRN referred patients within five business days of notification. Notifications will be in the form of e-mails from RPRN. Patient consultation will consist of but not be limited to, establishment of a patient chart, a complete medical history being taken and a full physical examination conducted. The examination may or may not result in a prescription medication being written for the patient.

After patient consultation, I agree to acknowledge the examination within 2 business days by logging into the physician section of the RPRN website, filling in all indicated/appropriate information for the patient. I understand and agree that record of the patient consultation will be shared with the patient as well as the patient selected affiliated RPRN pharmacy.

I understand it is my responsibility to immediately notify RPRN of any suspension or loss of DEA physician license, State physician license or malpractice insurance policy. Failure to do so can result in permanent removal from the RPRN.

Use of this website, and information distributed in conjunction with this website is offered to you on your acceptance of these Terms of Use, our Privacy Policy and other notices posted on this website. Your use of this website or of any content presented in any and all areas of the website indicates your acknowledgment and agreement to these Terms of Use, our Privacy Policy and other notices posted on this website. If you do not agree to be bound by and comply with all of the foregoing, you may not access or use our information, services, or website. We suggest you print a copy of each of these documents for your records.

RPRN shall have the right, at its sole discretion, to modify, add or remove any terms or conditions of these Terms of Use without notice or liability to you. Any changes to these Terms of Use shall be effectively immediately following the posting of such changes on this website. You agree to review these Terms of Use from time to time and agree that any subsequent use by you of this website following changes to these Terms of Use shall constitute your acceptance of all such changes.