formidableMD Payment and Billing Agreement
Last Updated: March 26, 2026
By clicking where indicated, I, the undersigned, hereby agree to the terms described in
this Payment and Billing Consent Agreement (“Agreement”). This includes, but is not limited to, (i) my financial responsibility for services, (ii)information about non-covered services, (iii) the cancellation policy.
1. Notice of Financial Responsibility for Services
I agree to pay formidableMD all applicable charges at the prices then in effect for the
Services provided to me. I authorize formidableMD to charge my chosen payment method
(your "Payment Method") for the Services provided to me. I acknowledge that my payment method will be charged upon confirmation of my appointment. If my Payment Method is
invalid at the time payment is due, I agree to pay all amounts due upon demand. I further acknowledge that if my payment is not paid upon demand, my appointment will be cancelled if not paid before 48hrs of my appointment time.
The third-party services provider who manages my Payment Method may impose terms and
conditions on me, which are independent of these Terms, and I agree to comply with all
of those terms. formidableMD reserves the right to correct any billing errors or mistakes even
if payment has already been requested or received.
2. Cancellation Policy
I understand that I may cancel my appointment for any reason before 48hrs of my scheduled appointment. A full refund will be automatically processed to the original form of payment within 3 business days. If the original form of payment is not available, a check will be issued within 30 days of the cancellation.
I understand that if I cancel my appointment within 48hrs of my scheduled appointment, a $75.00 cancellation fee will be charged to the preferred payment method on my account. If there is no valid payment option saved on the account. The visit amount will refunded minus the $75 cancellation fee within 3 business days. Please allow 5-10 business days after processing depending on banking institution to receive the refund back to your original form of payment. If the original form of payment is not available, a check will be issued within 30 days of the cancellation.
I further understand that within 48hrs of the appointment, formidableMD providers will begin review of my detailed questionnaire and pertinent health information that I have submitted as well as insurance formulary inquiry for prescriptions and therefore if I cancel my appointment within 48hrs of my appointment, I will be charged $75.00 for the cancellation fee.
3. Non-Covered Services
I understand that the cost of my visit does not include the cost of medications or lab testing and that the additional costs for medications and lab testing will be my financial responsibility.
I agree to be personally responsible for any costs not covered by the cost of my visit including but not limited to:
(i) all medications;
(ii) durable medical equipment;
(iii) medical supplies;
(iv) laboratory assessments;
(v) nutrition coaching
From time to time, formidableMD may present me with a choice of certain laboratory services
and their costs, which are not included in the cost of my visit. By purchasing such
laboratory services, I agree to pay formidableMD. I can choose to submit a claim to my Personal Health Insurance Plan or purchase laboratory services on a self-pay cash basis instead of utilizing my health insurance benefits. formidableMD is not responsible for any additional costs associated with obtaining laboratory assessments.
I understand, except as provided in this Agreement or the Terms and Conditions, neither
formidableMD nor the Providers make any representations whatsoever that any fees are or
are not covered by my Personal Health Insurance Plan.
4. Payment and Collections
I understand that formidableMD accepts credit and debit cards issued by U.S. banks. If a
credit card account is being used for a transaction, formidableMD may obtain preapproval
for an amount up to the amount of the payment.
formidableMD reserves the right to charge any outstanding post-claim balances to the
payment method on file. An invoice will be provided post-claim, with payment due within
15 days, at which point if payment has not been made yet, the card on file will be billed.
If payment is unsuccessful, you will have an additional 30 days to resolve the balance
before you will be suspended formidableMD pursuant to the Terms of Service. Notification,
where provided, is for your convenience and does not constitute an obligation on formidableMD’s part. You agree that any post-claim balances due will be processed
automatically, unless you contact formidableMD’s support team to address any outstanding
payment concerns prior to processing.
5. Agreement
By agreeing to this Payment and Billing Consent Agreement, I hereby acknowledge and
agree to all terms and requirements herein. I acknowledge that my digital signature or
other indication of acceptance of this Agreement shall be considered as effective and valid as an original signature.
I acknowledge my financial responsibility for any Health Care Services not covered by
the visit fee. I also agree to pay any fees and costs associated with products or services including laboratory assessments, medications and any products or services that I choose to purchase on a self-pay cash basis. Furthermore, I consent to the use of my credit or debit card for payment transactions.