Self Pay Acknowledgement and Financial Agreement

Last Updated: September 9, 2026

Clarity Life Medical P.A. and its affiliated entities, (collectively defined as “Group”) are committed to providing the best quality healthcare services. We do NOT participate in any insurance plans, including Medicare or Medicaid, and we do NOT accept any health insurance whatsoever. Our services are 100% self-pay by our patients. By accepting this Agreement, you acknowledge that one or more of the following applies: (1) you do not have health insurance, including Medicare, Medicaid, or any other federal or state healthcare program or commercial insurance plan; or (2) you have health insurance but are electing not to use any insurance benefit for the services described herein. In either case, you acknowledge that Group does not participate in or accept any health insurance plans, including Medicare and Medicaid, and that you are solely responsible for the full cost of all services.

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By accepting this Agreement, you are electing to purchase services on a self-pay basis. You agree to be 100% responsible for full payment of the listed price of the services. Certain services may be eligible for reimbursement through your Health Savings Account (HSA) or Flexible Spending Account (FSA). However, eligibility is not guaranteed, and it is your responsibility to confirm whether any purchase qualifies for HSA or FSA reimbursement under applicable laws and with your specific plan administrator. Group makes no representation or warranty that any particular service is or will remain HSA- or FSA-eligible. You are solely responsible for retaining appropriate documentation for tax or reimbursement purposes.

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Group has provided you with the charges, in advance, for the services you have requested. By accepting, you agree to pay these charges in full as a self-pay patient, electing not to use an insurance policy benefit. You have been given a choice of different services, along with their costs. You have selected the services and are willing to accept full financial responsibility for payment. If you are a federal health program beneficiary, you agree that neither you, Clarity Life, Inc., Group, or any of the health care organization(s) or provider(s) with whom we partner to provide health care services to you will submit a claim for reimbursement to any federal or state healthcare program for the costs of the services and products provided to you through the services. You understand that by choosing to receive services from Group on a self-pay basis, you are choosing to forgo any benefits that may otherwise be available to you under a federal or state healthcare program for the same or similar services obtained from a different provider.

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Membership Fees and Automatic Renewal

  • Your membership renews automatically until you cancel. We charge your payment method at the start of each billing period.
  • Your price and billing period are shown at checkout and in your order confirmation, and are part of this Agreement.
  • Cancel at any time by emailing hello@getclarity.health, at least 2 days before your renewal date to avoid the next charge. Cancellation takes effect at the end of the period you have paid for, and partial periods are not refunded.
  • We will notify you before any price change so you can cancel first. If you enrolled at a promotional rate, your order confirmation states when that rate ends and what you pay after.

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Authorization to Charge

Clinical services are provided by Group. Clarity Life, Inc. (“Clarity”) does not provide clinical services and collects fees on Group’s behalf. You authorize Clarity and its payment processor to charge the payment method you provide for your membership fee and any other amount you agree to in advance.

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Charges Not Included in Your Membership

Unless your plan states otherwise, you pay separately for supplements and other non-prescription products, prescriptions and pharmacy charges, testing beyond what your plan includes, and any in-person care, imaging, procedures, or referrals.

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Late Cancellation

If you miss a scheduled visit, or cancel or reschedule less than 24 hours before it starts, we may charge a late cancellation fee in the amount shown in your account and appointment confirmation. We will notify you before that amount changes.

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Our Financial Interest in Supplement Sales

When you buy a recommended product through the supplement dispensary on our platform, Clarity receives a portion of the purchase price and a member discount is applied to your price. No clinician is paid based on what you buy, and buying is never a condition of your care.

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Acceptance

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By signing below or electronically accepting this Agreement (including by clicking “I Agree,” checking a box, or using any other acceptance mechanism provided through the Service), I acknowledge that I have read, understand, and agree to the terms of this Agreement for Self-Payment of Services and to the financial and automatic renewal terms set out above. I agree that my electronic signature or acceptance has the same legal effect as a handwritten signature.