Article 1: Agreement to Arbitrate: it is understood that any dispute as to medical malpractice, that is as to whether any medical service rendered under this contract, were unnecessary or unauthorized, or were improperly, negligently, or incompetently rendered, will be determined by submission to arbitration as provided by state and federal law, and not by a lawsuit or resort to court process, except as state and federal law, provides for judicial review of arbitration proceedings. Both parties to this contract, by entering into it are giving up their constitutional right to have any such dispute, decided in a court of law before a jury, and instead, or accepting the use of arbitration.

Article 2: All claims must be arbitrated: It is also understood that any dispute that does not relate to medical malpractice, including disputes as to whether or not a dispute is subject to arbitration, wether this agreement is unconscionable, and any procedural disputes, will also be determined by submission to binding arbitration. It is the intention of the parties that this agreement bind all parties, as to all claims, including claims arising out of or relating to treatment or services provided by the healthcare provider, including any airs or past, present or future spouses of the patient in relation to all claims, loss of consortium. This agreement is also intended to bind any children of the patient whether born or unborn at the time of the occurrence giving rise to any claim. This agreement is intended to bind the patient and the healthcare provider and/or other license healthcare providers or preceptorship interns, who now, or in the future, treat the patient while employed by, working, or associated with or serving as back up for the healthcare provider, including those working at the healthcare providers clinic or office in any other clinic or office, whether signatories to this form or not.

All claims for monetary damages exceeding the jurisdictional limit of the small claims court against the healthcare provider, and/or the healthcare providers associates, association, corporation, partnership, employ, lawyers, agents and estate, must be arbitrated, including, without limitation, claims for loss of consortium, wrongful, death, emotional distress, injunctive, relief, or punitive damages.

Article 3: Procedures and Applicable Law: a demand for arbitration must be communicated in writing to all parties. Each party shall select an arbitrator (party arbitrator) within 30 days and a third arbitrator (neutral arbitrator) shall be selected by the arbitrators appointed by the parties within 30 days thereafter. The neutral arbitrator shall then be the sole arbitrator, and shall decide the arbitration. Each party to the arbitration shall pay such parties, pro rata, share of the expenses and fees of the neutral arbitrator, together with other expenses incurred by a party for such parties own benefit. Either party shall have the absolute right to buy for Kate, the issues of liability and damage upon written request to the neutral arbitrator.

The parties consent to the intervention and joiner in this arbitration of any person or entity, that would otherwise be a proper additional party in a court action and upon such intervention and joiner, any existing court action against any such person or entity, shall be stayed arbitration. The parties agree, that provisions of state and federal law, where, applicable, establishing the right to introduce evidence of any amount, payable as a benefit to the patient to the maximum extent permitted by law, limiting the right to recover non-economic losses, and the right to have a judgment for future damages, conformed to periodic payments, shall apply to disputes within this arbitration agreement. The parties further agree that the Commercial Arbitration rules of the American Arbitration Association shall govern any arbitration can conducted pursuant to this Arbitration Agreement.

Article 4: General Provision: all claims based upon the same incident, transaction, or related circumstances Shelby arbitrated in one proceeding. A claim shall be waived and forever barred, if (1) on the date, notice thereof is received, the claim, if asserted in a civil action, would be barred by the legal statue of limitations, or (2) the claimant fails to pursue the arbitration claim in accordance with the procedures, prescribed here in with reasonable diligence.

Article 5: Revocation: this agreement may be revoked by written notice, delivered to the healthcare provider within 30 days of signature, and, if not revoked, will govern all professional services received by the patient and all other disputes between the parties.

Article 6: Retroactive Effect: if patient intends this agreement to cover services rendered before the date, it is signed (for example, emergency treatment), patient should initial here. Effective as of the date of first professional services.

If any provision of this arbitration agreement is held invalid or unenforceable, the remaining provisions shall remain in full force, and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreement. By my signature below, I acknowledge that I have received a copy.

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