Main Street Dental Membership Club Terms and Conditions (the "Agreement")

I understand and acknowledge the following:

illumitrac Patient Disclosure Statement

1. I agree to the one-time member activation fees today. This fee includes my first month's dues. I understand that I am not prepaying for future services or for access to discounted services, but agreeing to make regular monthly subscription payments instead of paying at the time of each service covered under the membership club.
2. This Agreement does not provide comprehensive health insurance coverage. It provides only the health care services specifically described in the membership club.
3. Membership clubs run month-to-month and include an auto renewal feature. Club members can cancel their membership at any time.
4. I am responsible for any charges incurred for services provided that are not part of the Main Street Dental Membership Club. Main Street Dental will not bill insurance carriers for any services provided through the membership club.
5. I am voluntarily becoming a member of the Main Street Dental Membership Club and understand this Agreement is non-transferrable.
6. I will receive all communication regarding my account via email.
7. My future monthly dues will begin in approximately 30 days and they will be charged monthly after that time.
8. I may cancel my membership at any time by logging into the Member Portal (https://mydentalmembership.com/main-street-dental).
9. Member activation refunds are provided at the sole discretion of Main Street Dental; refund requests must be submitted directly to Main Street Dental within 30 days of this transaction.
10. Refunds will not be provided for subscription dues under any circumstances, including failure to schedule and maintain appointments.
11. iTrac, llc ("illumitrac") does not make any specific promises to you about the services. For example, illumitrac does not make any commitments about the quality of the services, the specific functions qualifications of the service provider, or their reliability, availability, or ability to meet your needs. illumitrac also does not make any warranties or commitment relating to non-infringement, freedom from viruses or other harmful code, or error-free or uninterrupted operations in its platform.
12. To the extent not prohibited by law, in no event will illumitrac be liable to you for any direct damages, or any special, incidental, exemplary, punitive, consequential or other indirect damages of any kind, relating to the services, whether based on contract, tort (including without limitation, negligence), warranty, guarantee or any other legal or equitable grounds, and even if a remedy fails of its essential purpose. You and your heirs, successors, and assigns hereby forever irrevocably release, discharge, and hold harmless illumitrac, our affiliates, and its and their successors and assigns, and its and their officers, directors, employees, and agents (collectively, "Illumitrac released parties") from, and agree not to sue any illumitrac released party for, any liabilities, claims, obligations, suits, actions, demands, expenses, and damages whatsoever (collectively, "Liabilities") that you may have against any illumitrac released party whether existing now or in the future, whether known or unknown, arising out of or in connection with your or illumitrac's conduct related to use of the services. You understand and acknowledge that the foregoing sentence releases and discharges all illumitrac liabilities, whether or not they are currently known to you, and you waive your rights under california civil code section 1542. You understand the meaning of california civil code section 1542, which reads as follows: "A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.
13. In the event that, notwithstanding the foregoing, illumitrac is held to be liable for damages or other relief, you agree that illumitrac's aggregate liability to you for any and all claims relating to the services shall not exceed an amount equal to the total fees received by illumitrac from you (if any) for the services to which such liability relates in the three (3) month period preceding the latest such claim.
14. Without limiting the waiver and release in Section 12 above, you agree to the following:
    • Purpose. Any and all Disputes (as defined below) involving you and illumitrac will be resolved through individual arbitration. In arbitration, there is no judge or jury and there is less discovery and appellate review than in court. This Section 17 (the "Arbitration Provision") shall be broadly interpreted. Notwithstanding anything to the contrary in this Agreement, this Section 17 does not apply to an action by either party to enjoin the infringement or misuse of its intellectual property rights, including copyright, trademark, patent or trade secret rights.
    • Definitions. The term "Dispute" means any claim or controversy between you and illumitrac related to the Services, including but not limited to any and all: (1) claims for relief and theories of liability, whether based in contract, tort, fraud, negligence, statute, regulation, ordinance, or otherwise; (2) claims that arose before this Agreement or any prior agreement; (3) claims that arise after the expiration or termination of this Agreement; and (4) claims that are currently the subject of purported class action litigation in which you are not a member of a certified class. As used in this Arbitration Provision, "illumitrac" means iTrac, LLC and any of its predecessors, successors, assigns, parents, subsidiaries and affiliated companies and each of their respective officers, directors, employees and agents, and "you" means you and any users or beneficiaries of your access to the Services.
    • Initiation of Arbitration Proceeding/Selection of Arbitrator. You or illumitrac may initiate the arbitration proceeding and open a case with JAMS, formerly Judicial Arbitration and Mediation Services, Inc., ("JAMS") by visiting its website (www.jamsadr.com) or calling its toll-free number (1-800-352-5267). You may deliver any required or desired notice to illumitrac by mail to 920 SW 6TH Ave, Suite 240, Portland, OR 97204.
    • Right to Sue in Small Claims Court. Notwithstanding anything in this Arbitration Provision to the contrary, either you or illumitrac may bring an individual action in a small claims court in the area where you access the Services if the claim is not aggregated with the claim of any other person and if the amount in controversy is properly within the jurisdiction of the small claims court.
    • Arbitration Procedures. This Arbitration Provision shall be governed by the Federal Arbitration Act. Arbitrations shall be administered by JAMS pursuant to its Streamlined Arbitration Rules and Procedures (the "JAMS Rules") as modified by the version of this Arbitration Provision that is in effect when you notify illumitrac about your Dispute. You can obtain the JAMS Rules from the JAMS by visiting its website (www.jamsadr.com) or calling its toll-free number (1-800-352-5267). If there is a conflict between this Arbitration Provision and the rest of this Agreement, this Arbitration Provision shall govern. If there is a conflict between this Arbitration Provision and the JAMS rules, this Arbitration Provision shall govern. If JAMS will not administer a proceeding under this Arbitration Provision as written, the parties shall agree on a substitute arbitration organization. If the parties cannot agree, the parties shall mutually petition a court of appropriate jurisdiction to appoint an arbitration organization that will administer a proceeding under this Arbitration Provision as written applying the JAMS Rules. A single arbitrator will resolve the Dispute. Unless you and illumitrac agree otherwise, any arbitration hearing will take place in Portland, OR. The arbitrator will honor claims of privilege recognized by law and will take reasonable steps to protect customer account information and other confidential or proprietary information. The arbitrator shall issue a reasoned written decision that explains the arbitrator's essential findings and conclusions. The arbitrator's award may be entered in any court having jurisdiction over the parties only if necessary for purposes of enforcing the arbitrator's award. An arbitrator's award that has been fully satisfied shall not be entered in any court.
    • Waiver of Class Actions and Collective Relief. There shall be no right or authority for any claims to be arbitrated or litigated on a class action, joint or consolidated basis or on bases involving claims brought in a purported representative capacity on behalf of the general public (such as a private attorney general), other subscribers, or other persons. The arbitrator may award relief only in favor of the individual party seeking relief and only to the extent necessary to provide relief warranted by that individual party's claim. The arbitrator may not consolidate more than one person's claims, and may not otherwise preside over any form of a representative or class proceeding.
    • Arbitration Fees and Costs. If your claim seeks more than $75,000 in the aggregate, the payment of the JAMS's fees and costs will be governed by the JAMS Rules. You may hire an attorney to represent you in arbitration. You are responsible for your attorneys' fees and additional costs and may only recover your attorneys' fees and costs in the arbitration to the extent that you could in court if the arbitration is decided in your favor. Notwithstanding anything in this Arbitration Provision to the contrary, illumitrac will pay all fees and costs that it is required by law to pay.
    • Severability and Waiver of Jury Trial. If any part of subsection (f) of this Arbitration Provision is found to be illegal or unenforceable, the entire Arbitration provision will be unenforceable and the Dispute will be decided by a court. WHETHER IN COURT OR IN ARBITRATION, YOU AND ILLUMITRAC AGREE TO WAIVE THE RIGHT TO A TRIAL BY JURY TO THE FULLEST EXTENT ALLOWED BY LAW. If any other clause in this Arbitration Provision is found to be illegal or unenforceable, that clause will be severed from this Arbitration Provision and the remainder of this Arbitration Provision will be given full force and effect.
    • Continuation. This Arbitration Provision will survive the termination or expiration of this Agreement.
15. I acknowledge and agree to the terms, conditions, and notices contained in the illumitrac Software Privacy Policy, which are incorporated herein by reference. I understand and acknowledge that this policy is available for my review at any time at https://mydentalmembership.com/main-street-dental/privacy-policy
16. I understand that fees, services, or location may be changed with 60 days' notice (for patients of dental offices located in Oregon, Nebraska, Tennessee, and Virginia).

Additional Terms and Conditions

1. Main Street Dental will not terminate this Agreement solely on the basis of my health status.
2. This Agreement is between me and Main Street Dental, and Main Street Dental is solely responsible and liable for, and I will look solely to Main Street Dental for the resolution of, any issues that arise in connection with the Main Street Dental Membership Club, the Member Portal, or the services performed by Main Street Dental (collectively, the "Services").

NOTICE: Membership Clubs are not an insurance policy, and may not qualify as the minimum essential health benefits required by the affordable care act. Patients covered by a qualified health plan under the aca may already have coverage for certain preventive care benefits at no cost. Medical services provided under this agreement may not be covered by your health insurance. Main Street Dental will not bill your insurance for services provided under membership clubs. You may be responsible for any payment for services under this agreement not covered by your insurance policy, including but not limited to prepayment for future services and payment for access to discounted services. Membership clubs are direct payment arrangements between club members and providers for services and care provided. Patients are encouraged to consult with their health insurance plans before entering into this agreement.

ALABAMA NOTICE: The agreement does not constitute health insurance of the laws of this state. An uninsured patient that enters into an agreement may still be subject to tax penalties under the patient protection and affordable care act, Public Law 111-148, for failing to obtain insurance. Patients insured by health insurance plans that are compliant with the patient protection and affordable care act already have coverage for certain preventive care benefits at no cost to the patient. Payments made by a patient for services rendered under a physician agreement may not count toward the patient's health insurance deductibles and maximum out-of-pocket expenses. A patient is encouraged to consult with the patient's health insurance plans before entering into the agreement and receiving care.

ARIZONA NOTICE: The organization facilitating the direct primary care agreement is not an insurance company and the direct primary care company guidelines and agreement are not an insurance policy. Participation in the direct primary care agreement or a subscription to any of its documents should not be considered to be a health insurance policy. Regardless of whether you receive treatment for health care issues through the direct primary care agreement, you are always personally responsible for paying any additional health care expenses you may incur. If you have health insurance, it may include, at no additional charge, some of the preventive services that are also available under this direct primary care agreement. The primary care provider may not bill your health insurance for primary care services provided under this direct primary care agreement.

COLORADO NOTICE: This agreement is not health insurance and does not meet any individual health benefit plan that may be required by federal law. Patients are not entitled to health insurance protection for consumers under colorado revised statutes title 10.

FLORIDA NOTICE: This agreement is not health insurance and the primary care provider will not file any claims against the patient's health insurance policy or plan for reimbursement of any primary care services covered by the agreement. This agreement does not qualify as minimum essential coverage to satisfy the individual shared responsibility provision of the patient protection and affordable care act, 26 U.S.C. S. 5000a. This agreement is not workers' compensation insurance and does not replace an employer's obligations under chapter 440.

IDAHO NOTICE: This agreement does not provide health insurance coverage, including the minimal essential coverage required by applicable federal law. It provides only the services described herein. It is recommended that health care insurance be obtained to cover medical services not provided for under this direct primary agreement.

KANSAS NOTICE: This medical retainer agreement does not constitute insurance, is not a medical plan that provides health insurance coverage for purposes of the federal patient protection and affordable care act and covers only limited, routine health care services as designated in this agreement.

MISSISSIPPI NOTICE: This agreement is not health insurance. Standing alone, the agreement does not satisfy the health benefit requirements as established in the federal affordable care act. Without adequate insurance coverage in addition to this agreement, the patient may be subject to fines and penalties associated with the federal affordable care act.

NEBRASKA NOTICE: This agreement does not constitute insurance and is not a medical plan that provides health insurance coverage for purposes of any federal mandates. This direct primary care agreement only provides for the primary care services described in the agreement. It is recommended that insurance be obtained to cover medical services not provided for under this direct primary care agreement. You are always personally responsible for the payment of any additional medical expenses you may incur.

OREGON NOTICE: This agreement is not insurance, and Main Street Dental does not provide insurance. Main Street Dental provides only the limited scope of primary care services specified in this agreement. Patients must pay for all services not specified in this agreement.

TENNESSEE NOTICE: This agreement does not constitute health insurance under the laws of this state. An uninsured patient that enters into a direct medical care agreement may be subject to tax penalties under the patient protection and affordable care act, Public Law 111-148, for failing to obtain insurance. Patients insured by health insurance plans that are compliant with the patient protection and affordable care act already have coverage for certain preventative care benefits at no cost to the patient. Payments made by a patient for services rendered under a direct medical care agreement may not count towards the patient's health deductibles and maximum out-of-pocket expenses. Patients are encourage to consult with their health insurance plans before entering into the agreement and receiving care. A direct medical care provider who breaches this agreement may be liable for damages and subject to discipline by the appropriate licensing board.

VIRGINIA NOTICE: This agreement does not provide comprehensive health insurance coverage. It provides only the provision of primary care as specifically described in this agreement.

WASHINGTON NOTICE: THIS AGREEMENT DOES NOT PROVIDE COMPREHENSIVE HEALTH INSURANCE COVERAGE. IT PROVIDES ONLY THE FOLLOWING HEALTH CARE SERVICES: Adult D1110, D0120, D0274, D0140, D0220. INFORMATION ABOUT PAYMENTS MADE AND SERVICES PROVIDED TO PATIENTS IS AVAILABLE UPON REQUEST. REFUNDS WILL BE PROVIDED FOR PATIENTS WHOSE SUBSCRIPTION PAYMENTS EXCEED THE VALUE OF SERVICES RENDERED. FEES MAY BE INCREASED ANNUALLY WITH 60 DAYS’ NOTICE. PATIENTS ARE ENCOURAGED TO OBTAIN AND MAINTAIN INSURANCE FOR SERVICES NOT COVERED UNDER THIS AGREEMENT. Main Street Dental WILL NOT BILL A CARRIER FOR SERVICES COVERED UNDER THIS AGREEMENT. PATIENTS HAVE FINANCIAL RIGHTS AND Main Street Dental MAY NOT DECLINE TO ACCEPT NEW PATIENTS OR DISCONTINUE CARE TO EXISTING PATIENTS SOLELY BECAUSE OF THE PATIENT'S HEALTH STATUS. PATIENTS ALSO HAVE RESPONSIBILITIES TO Main Street Dental AND Main Street Dental MAY DISCONTINUE CARE FOR PATIENTS IF: (A) THE PATIENT FAILS TO PAY THE FEE UNDER THE TERMS REQUIRED BY THIS AGREEMENT; (B) THE PATIENT HAS PERFORMED AN ACT THAT CONSTITUTES FRAUD; (C) THE PATIENT REPEATEDLY FAILS TO COMPLY WITH THE RECOMMENDED TREATMENT PLAN; (D) THE PATIENT IS ABUSIVE AND PRESENTS AN EMOTIONAL OR PHYSICAL DANGER TO THE STAFF OR OTHER PATIENTS OF Main Street Dental; OR (E) Main Street Dental DISCONTINUES OPERATION AS A DIRECT PRACTICE. THE CONTACT INFORMATION FOR THE OFFICE OF THE INSURANCE COMMISSIONER OF WASHINGTON STATE IS AS FOLLOWS. ADDRESS: 302 SID SNYDER AVE. SW, SUITE 200, OLYMPIA, WA 98501. TELEPHONE: 360-725-7000. ADDITIONAL CONTACT INFORMATION MAY BE AVAILABLE AT HTTPS://WWW.INSURANCE.WA.GOV/CONNECT-US OR CALL 800-565-6900.