Effective date: January 14th, 2026
This Patient Agreement (this "Agreement") governs your use of the health care and other professional clinical services, including via telehealth ("Clinical Services") provided by Lavela Provider Network CA, P.C., a California professional corporation ("Provider Group", "we" or "us") and the physicians, allied health professionals, and other licensed professionals we employ or engage as contractors (each a "Provider" and collectively the "Providers"). Please read this Agreement carefully before receiving Clinical Services from Provider Group.
Lavela Health Inc. ("Lavela") provides management and technology services to Provider Group and also provides certain non-clinical products and services to individuals who register as users of its services ("Lavela Services"), and the Lavela Health Terms of Use govern your use of the Lavela Services provided by Lavela Health Inc. Please read the Lavela Health Terms of Use carefully before using both the Clinical Services and the Lavela Services.
By accepting this Agreement as either the patient or the patient's legal representative, parent, guardian, conservator, or custodian of a minor child under 18 years of age (except as otherwise permitted by the laws of the state in which you are located if younger than 18, or such higher age of majority under applicable state law) or other person lacking the ability to consent (collectively "you" or "your"), you acknowledge to have read, accepted and become legally bound to the terms and conditions set forth below, including the Telehealth Services Consent contained in this Agreement. We reference the Lavela website, which we also use, as the "Site" in this Agreement.
Please refer to our Privacy Policy to learn how we collect, use, share, and protect your data.
YOU AGREE THAT DISPUTES BETWEEN YOU AND PROVIDER GROUP WILL BE RESOLVED BY BINDING, INDIVIDUAL ARBITRATION UNLESS YOU OPT-OUT IN ACCORDANCE WITH THE DISPUTE RESOLUTION PROCESS DESCRIBED IN SECTION 10 BELOW. UNLESS YOU OPT-OUT OF ARBITRATION, YOU ARE WAIVING YOUR RIGHT TO A TRIAL BY JURY OR TO PARTICIPATE AS A PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS ACTION OR REPRESENTATIVE PROCEEDING. IF YOU WISH TO OPT OUT OF ARBITRATION, FOLLOWING THE OPT-OUT PROCEDURE SPECIFIED IN SECTION 10.
DO NOT USE THE CLINICAL SERVICES, INCLUDING VIA TELEHEALTH, FOR EMERGENCY OR LIFE-THREATENING MEDICAL MATTERS. FOR ALL LIFE-THREATENING MATTERS, IMMEDIATELY CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM. THE CLINICAL SERVICES ARE NOT APPROPRIATE FOR ALL MEDICAL CONDITIONS OR CONCERNS. THIS AGREEMENT IS SUBJECT TO CHANGE AS PROVIDED HEREIN.
Provider Group may, in its sole discretion, without prior notice to you, revise this Agreement at any time. Should this Agreement change materially, Provider Group will update the Effective Date noted above and post a notice regarding the updated Agreement. If you do not agree with the proposed changes, you should discontinue your use of the Clinical Services before the effective date of the change. If you continue using the Clinical Services after the Effective Date, you will be bound by the updated Agreement.
You agree to pay Provider Group all applicable charges and payment responsibility at the prices then in effect for the Clinical Services provided to you. You will be charged for the Clinical Services provided to you by a Provider. You authorize Provider Group and its agents, including Lavela, to charge your designated Payment Method (defined below) for the Clinical Services provided to you.
We use a third-party payment processor (the "Payment Processor") to bill you through a payment account linked to your account registered with Lavela (your "Billing Account") for the Clinical Services. The processing of payments will be subject to the terms, conditions and privacy policies of the Payment Processor in addition to this Agreement. Currently, we use Stripe, Inc. as our Payment Processor. You can access Stripe's Terms of Service at https://stripe.com/us/checkout/legal and their Privacy Policy at https://stripe.com/us/privacy. We are not responsible for any error by, or other acts or omissions of, the Payment Processor. By choosing to receive Clinical Services, you agree to pay us, through the Payment Processor, all charges at the prices then in effect for the Clinical Services in accordance with the applicable payment terms, and you authorize us and Lavela (as our agent), through the Payment Processor, to charge your chosen payment method (your "Payment Method"). You agree to make payment using that selected Payment Method. We reserve the right to correct any errors or mistakes that the Payment Processor makes even if it has already requested or received payment.
The terms of your payment will be based on your Payment Method and may be determined by agreements between you and the financial institution, credit card issuer or other provider of your chosen Payment Method. If we, through the Payment Processor, do not receive payment from you, you agree to pay all amounts due on your Billing Account upon demand.
YOU MUST PROVIDE CURRENT, COMPLETE AND ACCURATE INFORMATION FOR YOUR BILLING ACCOUNT. YOU MUST PROMPTLY UPDATE ALL INFORMATION TO KEEP YOUR BILLING ACCOUNT CURRENT, COMPLETE AND ACCURATE (SUCH AS A CHANGE IN BILLING ADDRESS, CREDIT CARD NUMBER, OR CREDIT CARD EXPIRATION DATE), AND YOU MUST PROMPTLY NOTIFY US OR OUR PAYMENT PROCESSOR IF YOUR PAYMENT METHOD IS CANCELED (E.G., FOR LOSS OR THEFT) OR IF YOU BECOME AWARE OF A POTENTIAL BREACH OF SECURITY, SUCH AS THE UNAUTHORIZED DISCLOSURE OR USE OF YOUR USER NAME OR PASSWORD. CHANGES TO SUCH INFORMATION CAN BE MADE AT ACCOUNT SETTINGS.
Provider Group is NOT enrolled with, and does not currently participate as a participating provider with, any federal or state healthcare programs (i.e., Medicare or Medicaid) for the provision of any health care services or supplies. Provider Group also does NOT accept any commercial health insurance. As such, neither you nor Provider Group may receive payment from such government programs and health insurers for the services or products provided to you by Provider Group. By choosing to receive the Clinical Services, you are specifically choosing to obtain Clinical Services on a cash basis. Thus, you are solely responsible for the costs of any Clinical Services provided to you.
To the extent Provider Group later decides to accept commercial insurance and you provide information about your plan, we will deem your provision of the plan information as your authorization for us to submit claims for covered Clinical Services to your health insurer or health plan. In that case, you hereby:
You hereby give permission to Provider Group and its Providers to care for you. You may withdraw this consent at any time by no longer seeking Clinical Services from Provider Group. You understand that if you refuse recommended care, you will not hold Provider Group or any of the Providers responsible for any consequences of your refusal of care.
You understand and agree that as part of providing Clinical Services to you, your medical information may be uploaded to and documented in an online personal health record maintained by Provider Group and shared with Providers electronically.
The Clinical Services provided by Provider Group are regulated by state and federal laws and, as such, your access to the Clinical Services may be limited based on your state and your location at the time of accessing the Clinical Services. By accessing or using the Clinical Services, you represent and warrant that you are not prohibited from enrolling in or receiving the Clinical Services under the laws any applicable jurisdiction in which you may reside or are located. Use of the Clinical Services is limited to users located in states within the United States where the Clinical Services are available, and the Clinical Services are not available for users located outside of the United States. PLEASE NOTE THAT YOU MUST BE PHYSICALLY LOCATED IN THE STATE OF YOUR PROVIDER'S LICENSURE AT THE TIME YOU ENGAGE IN ANY CLINICAL SERVICES.
PLEASE BE SURE TO EMAIL SUPPORT@LAVELAHEALTH.COM OR CANCEL YOU APPOINTMENT THROUGH YOUR LAVELA HEALTH ACCOUNT AT LEAST TWENTY-FOUR (24) HOURS AHEAD OF THE SCHEDULED SESSION IF YOU NEED TO CANCEL YOUR APPOINTMENT. IF YOU MISS AN APPOINTMENT WITHOUT 24 HOURS' ADVANCE NOTICE, PROVIDER GROUP MAY CHARGE TO YOUR ACCOUNT A FEE OF EQUAL TO THE FEE OF YOUR MISSED SESSION WITH YOUR PROVIDER.
You may terminate your use of the Clinical Services at any time by not using the Clinical Services anymore. Please see the Lavela Terms of Use with respect to termination of the Lavela Services.
We may terminate your use of the Clinical Services at any time in our reasonable discretion, for causes including but not limited to illegal conduct such as falsifying information to obtain controlled substances, abusive and threatening behavior, consecutive missed appointments, and continued refusal to pay for the Clinical Services. We may terminate your use of the Clinical Services by sending notice to you at the mail or email address you provided to us or by otherwise contacting you. Termination of the Clinical Services will also result in termination of your Lavela Services from Lavela, in accordance with the Lavela Terms of Use.
You agree that we may send the following to you by email or by posting them on the Site: (i) legal disclosures; (ii) this Agreement, including the Telehealth Services Consent set forth below; (iii) future changes to any of the above; and (iv) other notices, policies, communications or disclosures, and information related to the Clinical Services.
By signing up for the Clinical Services and providing us with your wireless number, you confirm that you want Provider Group to send you information that we think may be of interest to you, which may include us using automated dialing technology to text you at the wireless number you provided, and you agree to receive communications from us via messaging, email, phone, text, or mail, and you represent and warrant that each person you register for the Clinical Services or for whom you provide a wireless phone number has consented to receive communications from Provider Group. You agree to indemnify and hold Provider Group harmless from and against any and all claims, liabilities, damages (actual and consequential), losses and expenses (including attorneys' fees) arising from or in any way related to your breach of the foregoing. You agree to update your contact information to ensure accuracy.
If you later decide that you do not want to receive certain future communications electronically, you may opt out of such communications through your account or by following the unsubscribe instructions in any communication you receive from Provider Group. Your withdrawal of consent will be effective within a reasonable time after we receive your withdrawal notice described above. If you withdraw your consent to receive communications electronically, certain Clinical Services may become unavailable to you. However, Provider Group will still need to send you certain communications electronically regarding the Clinical Services that you will not be able to opt out of — e.g., communications regarding updates to this Agreement or information about billing.
Your withdrawal of consent will not affect the legal validity or enforceability of the Agreement provided to and accepted by you.
Provider Group may directly provide Clinical Services to you using virtual technology, including via digital or automated tools, including without limitation tools for teletherapy (the "Telehealth Services").
Telehealth may be used for diagnosis, treatment, care, follow-up and/or patient education, and may include, without limitation, the following: (i) electronic transmission of patient health information, and/or other patient data or information; (ii) synchronous (i.e., "real time") and asynchronous (i.e., non-"real time") interactions via audio, video, text, and/or data or other electronic communications; and (iii) automated, electronic or digital tools or services for diagnosis, care, treatment and/or communication pertaining to healthcare matters; and output, transmission or exchange of data from devices, sound and video files. You also acknowledge that such virtual encounters may involve care by a variety of types of Providers, including but not limited to physicians, psychologists, licensed clinical social workers, and licensed marriage and family therapists in accordance with applicable laws and regulations.
You understand that virtual encounters required to receive the Telehealth Services via phone, email, video, or otherwise, could involve certain limitations and risk, including those detailed below, and you consent to the use of automated tools for diagnosis, care, treatment or communication pertaining to healthcare matter and agree to the following terms with respect to use of the Telehealth Services:
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, EXCEPT IN CASE OF GROSS NEGLIGENCE OR WILLFUL MISCONDUCT, WE AND LAVELA HEALTH INC. AND OUR AND THEIR RESPECTIVE EMPLOYEES, CONTRACTORS, OFFICERS, DIRECTORS, AND AGENTS WILL NOT BE RESPONSIBLE FOR ANY LOSS OR DAMAGE, INCLUDING PERSONAL INJURY OR DEATH, RESULTING FROM ANYONE'S RECEIPT OF OR INABILITY TO RECEIVE THE CLINICAL SERVICES.
The Clinical Services are intended for use only within the United States. We make no representation that the Clinical Services are appropriate or are available for use outside the U.S. or outside of the states in which Provider Group operates its practice. Those who choose to access and use the Clinical Services from outside the U.S. do so on their own initiative, at their own risk, and are responsible for compliance with applicable laws.
For California patients, the state of California requires that physicians in California share notice of the Open Payments database. The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at CMS Open Payments.
TO THE MAXIMUM EXTENT NOT PROHIBITED BY LAW, IN NO EVENT WILL WE AND LAVELA HEALTH INC. AND OUR AND THEIR RESPECTIVE EMPLOYEES, CONTRACTORS, OFFICERS, DIRECTORS, AND AGENTS BE LIABLE FOR ANY CONSEQUENTIAL, EXEMPLARY, INCIDENTAL, SPECIAL OR PUNITIVE DAMAGES, INCLUDING WITHOUT LIMITATION THOSE RELATING TO LOST PROFITS OR THE COST OF SUBSTITUTE PRODUCTS OR SERVICES ARISING OUT OF OR IN CONNECTION WITH THE CLINICAL SERVICES OR FROM THE RECEIPT OF OR INABILITY TO RECEIVE THE CLINICAL SERVICES, WHETHER BASED ON CONTRACT, WARRANTY, PRODUCT LIABILITY, TORT OR OTHER LEGAL THEORY AND EVEN IF WE HAVE BEEN INFORMED OF THE POSSIBILITY OF SUCH DAMAGES. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SO THE ABOVE EXCLUSION MAY NOT APPLY TO YOU.
You agree that any dispute, claim or controversy arising out of or relating to this Agreement or the Clinical Services (collectively, "Disputes") will be settled by binding arbitration, except that each party retains the right: (i) to bring an individual action in small claims court and (ii) to seek injunctive or other equitable relief in a court of competent jurisdiction to prevent the actual or threatened infringement, misappropriation or violation of a party's copyrights, trademarks, trade secrets, patents or other intellectual property rights (the action described in the foregoing clause (ii), an "IP Protection Action"). You will also have the right to litigate any other Dispute if you provide us with written notice to opt out of arbitration ("Arbitration Opt-out Notice") by email at support@lavelahealth.com or by regular mail to Lavela Health Inc. at 149 S. Barrington Avenue, #134, Los Angeles, CA 90049 within thirty (30) days following the date you first accept this Agreement. If you don't provide us with an Arbitration Opt-out Notice within the thirty (30) day period, you will be deemed to have knowingly and intentionally waived your right to litigate any Dispute except as expressly set forth in clauses (i) and (ii) above. The exclusive jurisdiction and venue of any IP Protection Action or, if you timely provide us with an Arbitration Opt-out Notice, will be the state and federal courts located in Los Angeles County, California and each of the parties to this Agreement waives any objection to jurisdiction and venue in such courts. Unless you timely provide us with an Arbitration Opt-out Notice, you acknowledge and agree that you are each waiving the right to a trial by jury or to participate as a plaintiff or class member in any purported class action or representative proceeding. Further, unless you otherwise agree in writing, the arbitrator may not consolidate more than one person's claims, and may not otherwise preside over any form of any class or representative proceeding. If a decision is issued stating that applicable law precludes enforcement of any limitations set forth in this Agreement to Arbitrate on the right to arbitrate claims on a class or representative basis, or as part of a consolidated proceeding, as to a given claim for relief, then that claim (and only that claim) must be severed from the arbitration and brought in the state or federal courts located in Los Angeles County, California. All other claims will be arbitrated. This "Dispute Resolution" section will survive any termination of this Agreement.
The arbitration will be administered by the American Arbitration Association ("AAA") in accordance with the Commercial Arbitration Rules and the Supplementary Procedures for Consumer Related Disputes (the "AAA Rules") then in effect, except as modified by this "Dispute Resolution" section. (The AAA Rules are available at https://www.adr.org/Rules or by calling the AAA at 1-800-778-7879.) The Federal Arbitration Act will govern the interpretation and enforcement of this Section.
A party who desires to initiate arbitration must provide the other party with a written Demand for Arbitration as specified in the AAA Rules. AAA provides a general form for a Demand for Arbitration. The arbitrator will be either a retired judge or an attorney licensed to practice law and will be selected by the parties from the AAA's roster of arbitrators. If the parties are unable to agree upon an arbitrator within seven (7) days of delivery of the Demand for Arbitration, then the AAA will appoint the arbitrator in accordance with the AAA Rules
Unless you agree with us otherwise, the arbitration will be conducted in the county where you reside. If your claim does not exceed $10,000, then the arbitration will be conducted solely on the basis of the documents that are submitted to the arbitrator, unless you request a hearing or the arbitrator determines that a hearing is necessary. If your claim exceeds $10,000, your right to a hearing will be determined by the AAA Rules. Subject to the AAA Rules, the arbitrator will have the discretion to direct a reasonable exchange of information by the parties, consistent with the expedited nature of the arbitration.
The arbitrator will render an award within the time frame specified in the AAA Rules. The arbitrator's decision will include the essential findings and conclusions upon which the arbitrator based the award. Judgment on the arbitration award may be entered in any court having jurisdiction thereof. The arbitrator's award of damages must be consistent with the terms of the "Limitation of Liability" section above as to the types and amounts of damages for which a party may be held liable. The arbitrator may award declaratory or injunctive relief only in favor of the claimant and only to the extent necessary to provide relief warranted by the claimant's individual claim. If you prevail in arbitration, you will be entitled to an award of attorneys' fees and expenses to the extent provided under applicable law. We will not seek, and hereby waive all rights we may have under applicable law to recover, attorneys' fees and expenses if we prevail in arbitration.
Your responsibility to pay any AAA filing, administrative and arbitrator fees will be solely as set forth in the AAA Rules. However, if your claim for damages does not exceed $75,000, we will pay all such fees unless the arbitrator finds that either the substance of your claim or the relief sought in your Demand for Arbitration was frivolous or was brought for an improper purpose (as measured by the standards set forth in Federal Rule of Civil Procedure 11(b)).
Notwithstanding anything to the contrary in this Agreement, if we change this "Dispute Resolution" section after the date you accepted this Agreement or receive the Clinical Services, you may reject any such change by sending us written notice (including by email to support@lavelahealth.com) within 30 days of the date such change became effective, as indicated in the "Effective Date" listed at the beginning of this Agreement or in the date of our email to you notifying you of such change. By rejecting any change, you are agreeing that you will arbitrate any Dispute between you and us in accordance with the provisions of this "Dispute Resolution" section as of the date you accepted this Agreement or received the Clinical Services.
No Dispute arising under or in connection with this Agreement, regardless of the form, may be brought by you more than one (1) year after the cause of action arose; actions brought thereafter are forever barred.
This Agreement and any supplemental terms, policies, rules and guidelines posted on the Site, each of which are incorporated in this Agreement by reference, constitute the entire agreement relating to your receipt of the Clinical Services between you and Provider Group and supersede all previous written or oral agreements. The failure of either party to exercise in any respect any right provided for in this Agreement shall not be deemed a waiver of any further rights under this Agreement.
This Agreement is governed by and will be construed under the Federal Arbitration Act, applicable federal law, and the laws of the State of California, without regard to any conflicts of laws provisions.
We may change, suspend, or discontinue any of the Clinical Services at any time. We will try to give you prior notice of any material changes to the Clinical Services. We will not be liable to you or to any third party for any modification, suspension or discontinuance of the Clinical Services.
Except as expressly set forth in the section above regarding the arbitration agreement, you and Provider Group agree there are no third-party beneficiaries intended under this Agreement. You may not transfer any of your rights or obligations under this Agreement to anyone else without our consent. We may assign our rights in connection with a merger, acquisition, or sale of assets, or by operation of law or otherwise.
We appreciate your feedback, suggestions, and other communications (collectively, "Feedback") about the Clinical Services. You may submit Feedback by emailing us, reaching out to our social networking accounts, or by other means of communication. Any Feedback you submit to us may be considered non-confidential and non-proprietary to you. By submitting Feedback to us, you grant us a non-exclusive, worldwide, royalty-free, irrevocable, sub-licensable, perpetual license to use and publish such Feedback for any purpose, without compensation to you.
Even after termination, this Agreement will remain in effect such that all terms that by their nature may survive termination will be deemed to survive such termination, including but not limited to the provisions of this Agreement concerning disclaimers, limitation of liability, dispute resolution, and jurisdictional issues.
In the event any one or more of the provisions of this Agreement shall for any reason be held to be invalid, illegal or unenforceable, the remaining provisions of this Agreement shall be unimpaired. Further, the invalid, illegal or unenforceable provision shall be replaced by a provision that comes closest to the intention of the parties that underlie the invalid, illegal or unenforceable provision, except to the extent no such provision is valid, legal and enforceable, in which case such invalid, illegal or unenforceable provision shall be limited or eliminated to the minimum extent necessary so that the other provisions of this Agreement remain in full force and effect and enforceable.
CALIFORNIA
NOTICE TO CONSUMERS
Medical doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov
Complaints may be filed online at http://www.mbc.ca.gov/Breeze/Complaints.aspx or submitted in hard copy form. A Consumer Complaint Form, including instructions for completing it may be found at http://www.mbc.ca.gov/Consumers/Complaints/Submit_By_Mail.aspx. A hard copy Consumer Complaint Form should be submitted to:
Medical Board of California
Central Complaint Unit
2005 Evergreen Street, Suite 1200
Sacramento, CA 95815
The Central Complaint Unit of the Medical Board of California is found by calling 1-800-633-2322 or by calling 916-263-2382.