Patient Signature Page

  • Phoenix Medical Solutions, LLC.
    PO Box 231 Brooklandville, MD 21022-0231
    (Toll Free) 855-825-8960(Fax) 866-242-4015

    Terms & Conditions
  • Please Read:
    By renting and or purchasing item (s) from Phoenix Medical Solutions, LLC (“Phoenix”), the Renter, or Purchaser, or the agent or other representative of the Customer (all referred to as the “Customer” herein) engage in our service and agree to be bound by the following terms and conditions:
  • Products4 weeksAdditional Weeks
    QA-250$120$30 per week
    SW-500$140$35 per week
    JR-250$140$25 per week
    ATV SW-500$160$40 per week
    LW-300$160$35 per week
    Wheelchair$100$25 per week
    Cold Therapy$150/3 weeks
    $100/wrap (non refundable)
    $50 per week
  • DELIVERY IS FREE FOR ALL RENTAL EQUIPMENT RENTED FOR A MINIMUM OF 4 WEEKS (3 WEEKS COLD THERAPY).
    *All equipment rentals will be charged initially on a 4-week basis per above, with the exception of cold therapy*. Should the Customer desire to rent equipment for less than 4 weeks (3 weeks cold therapy), the Customer will be charged the actual roundtrip shipping cost, if shipped, or $55 for local delivery and pickup. Customer will be refunded once the rental equipment has been received by Phoenix at the weekly rate for each full week the equipment was returned. For rentals that exceed 4 weeks (3 weeks for cold therapy), the Customer will be charged on a per week basis and will continue to be charged on a weekly basis until the rental equipment has either been returned or has been rented for 16 weeks (7 weeks cold therapy) at which point it will be deemed purchased. Delivery charges will apply for expedited delivery requests. A $55 charge will be assessed for missed appointments (MD appointments only). Returns must be sent back in the same box OR same box dimensions to avoid any oversized shipment charges to the customer. Returning devices from a different state without notifying Phoenix may result in an added shipment fee to the customer.
    Purchases: Phoenix has the authority to charge the Customer for the full cost of the product ordered using the payment method provided by the Customer. Purchased items may be returned for refund if returned within 3 days unused & unopened. Customer will be responsible for shipping/delivery charges and a restocking fee of 15% to 25% based on manufacturer’s policy.
    Additional Fees: Customer will be charged for credit card chargeback fees on disputed items that were validated in favor of Phoenix. A 20%/mo. interest charge will be assessed on all amounts not paid from the date the payment was due. Repossession & collection fees will be charged to the Customer if the equipment and or outstanding balances have not been received by Phoenix.
    State of Equipment: Customer acknowledges receipt of the leased equipment in good and working condition. The Customer pledges to maintain the leased equipment in the same good and proper working condition. Customer authorizes Phoenix to automatically charge the Customer under this Agreement for any repair or replacement costs incurred by Phoenix to restore the leased equipment back to its condition when the Customer received it. PHOENIX MAKES NO WARRANTY OF ANY KIND (MERCHANTIABILITY ETC) REGARDING THE RENTED AND OR PURCHASED EQUIPMENT; CUSTOMER TAKES THE EQUIPMENT ON AS “AS IS” BASIS. Phoenix may, but is not required to, replace the equipment with identical or similar equipment if the equipment fails to operate in accordance with the manufacturer’s specifications & operation instructions. Such replacement shall be made as soon as practicable after Customer returns the equipment.
    Insurance: Phoenix does not accept insurance nor is Phoenix a Medicare provider and does not accept assignment. All charges are the Customer’s sole responsibility. It is the Customer’s sole responsibility to verify insurance coverage for reimbursement purposes. Phoenix does accept Worker’s Comp. In the result the Worker’s Comp. company does not pay in full the amount owed to Phoenix, Customer accepts responsibility to pay the remaining balance owed to Phoenix.
    Indemnification, Disclaimer of Warranties; Limitation of Liability: Customer shall not pledge or encumber the equipment in any way. Customer agrees to indemnify and hold harmless Phoenix, its respective affiliated enterprises, regents, officers, directors, attorneys, employees, representatives & agents from & against all damages, losses, liens, causes of action, suits, judgments, expenses (including reasonable attorneys’ fees), & other claims of any nature, kind, or description by any person or entity, arising out of, caused by, or resulting from Phoenix’s performance under this Agreement & which are caused in whole or in part by any negligent act, negligent omission or willful misconduct of Phoenix, anyone directly or indirectly employed by Phoenix or anyone for whose acts Phoenix may be liable. Customer shall pay all reasonable attorneys, repossession & other fees, the expenses & costs incurred by Phoenix under these terms and conditions.
    If Customer is in default of any of the terms & conditions of the Agreement, Phoenix, at the Customer’s risk, cost & expense may at any time enter Customer’s premises to recover the product(s). Phoenix reserves the right to refuse to rent to anyone for any reason within Phoenix’s sole & absolute discretion. Any representative executing this Agreement in a representative capacity shall be bound personally, jointly & severally, with such fiduciary, corporation or other entity as to all obligations, expressed or implied, arising under this Agreement.
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