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Medical School Name & Graduation Date
Fellowship & Graduation Date
Residency & Graduation Date
On-par Insurances (if any)
Years as a Doctor
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Please Provide 3 References (must be physicians in the community)
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Social Security or TaxID
Mobile Phone number
Fellowship & Graduation Date
On-par Insurances (if any)
In consideration for access to the Site, and obtaining Services by Stitch Me Up and its Providers, Individual expressly acknowledges and agrees to the following:
No Patient-Physician Relationship. Nothing in this User Agreement, by itself, creates a patient-physician relationship between or among Stitch Me Up, Provider, and Individual until such time as Provider determines, in Provider’s sole discretion: a) whether Provider desires to provide Services to Individual once Provider performs an on-site, in person, evaluation; and 2) whether Individual’s medical needs are within the realm of normative, non-emergency basis plastic surgery services for which Provider elects to perform Services. Thus, in Provider’s sole and absolute discretion, Stitch Me Up may elect not to perform Services if Provider determines that Individual’s medical condition renders Individual to be an inappropriate candidate for Services for any reason or no reason. A patient-physician relationship will only be formally established upon a Provider performing Services on an individual. In the event of an emergency, please call 911 or visit your nearest emergency room. Individual expressly acknowledges and agrees that if Provider declines to perform Services, Individual may need to obtain care at another facility. Thus, Individual is seeking to obtain non-emergency Services.
Insurance Information. Individual represents and warrants to Stitch Me Up and Provider that any and all insurance and background information that Individual provides to Stitch Me Up, Provider, and their agents are true and accurate, and to the extent that there are errors, omissions, or falsities concerning such insurance coverage, individual will be personally liable for all applicable professional fees, including those above network charges (“Fees”).
Individual expressly acknowledges and agrees that Provider may be non-participating (i.e., not have a contract with a health plan to provide health care services to an insured) with Individual’s health plan, and to the extent that the Services are performed at a participating hospital or ambulatory surgical center where a participating physician is available, Individual is expressly requesting that Provider perform the Services, it being acknowledged that Provider may be non-participating.
Individual expressly acknowledges and agrees that Provider may be non-participating (i.e., not having a contract with a health plan to provide health care services to an insured), and to the extent that a participating (i.e., a physician having a contract with a health care plan to provide health care services to an insured) physician recommends that Individual receive Services by Provider, Individual expressly acknowledges and agrees that Provider’s Services may be out of network and may result in costs not covered by the Individual’s health plan.
To the extent that Individual is not insured for Services rendered by Provider, Individual acknowledges receipt of the disclosures detailed in Section A(2)(c) of this User Agreement (below).
Disclosures. Individual acknowledges and agrees that:
Individual has had the ability to determine, through Stitch Me Up’s website, a list of those health care plans in which Provider and Stitch Me Up are participating providers (as such list may be amended from time to time by Stitch Me Up in its discretion, without prior notice) and the hospitals with which the Provider is affiliated prior to the provision of non-emergency Services, as well as verbally at the time the appointment is scheduled.
Prior to the provision of non-emergency Services, the amount or estimated amount the Provider will bill the Individual for Services is available upon request.
Individual will receive from Stitch Me Up and Provider, if requested, the amount or estimated amount that Provider and Stitch Me Up will bill the Individual for Services provided or anticipated to be provided, absent unforeseen medical circumstances that may arise when the Services are provided.
Provider will provide (or exercise reasonable efforts to cause the facility at which the procedures are being performed to provide) the Individual with the name, practice name, mailing address, and telephone number of any health care provider scheduled to perform anesthesiology, laboratory, pathology, radiology or assistant surgeon services in connection with the Services in the Provider’s office for the patient or coordinated or referred by the physician for the patient at the time of referral to or coordination of services with such provider.
To the extent applicable, Provider will, for Individual’s scheduled hospital admission or scheduled outpatient hospital services, provide the Individual and hospital with the name, practice name, mailing address and telephone number of any other physician whose services will be arranged by the Provider and are scheduled at the time of the pre-admission testing, registration or admission at the time non-emergency Services are scheduled, as well as information as to how to determine the health care plans in which the Provider participates.
The Site may contain user-provided information (including information provided by Providers) (collectively, “Content”). Stitch Me Up cannot guarantee that the Content contained on the Site is accurate or complete, and it will not be responsible for any errors or omissions in the Content or for the results obtained from the use of such Content. All Content should be verified by you with any Provider, particularly in circumstances where Individual finds the Content relevant to their selection of a particular Provider.
Individual Liable for all Fees. Individual acknowledges and agrees that Individual is expressly requesting that Stitch Me Up and Providers provide Individual with Services that potentially might be out-of-network and, in any case, Individual will be fully and personally responsible for all Fees for Stitch Me Up’s and its Providers’ Services, as well as for any and all applicable cancelation fees for cancelation of requests for Services in accordance with Stitch Me Up’s policies. Fees are established and subject to modification by Stitch Me Up from time to time by Stitch Me Up without prior notice. Individual understands and agrees that, in certain circumstances, Stitch Me Up will bill the Individual for all Fees and Individual will pay such Fees upon receipt. By providing Individual’s credit card account information for payment of Fees and other charges, Individual represents and warrants that the credit card that Individual provides is owned by Individual and Individual authorizes Stitch Me Up to charge Individual for all applicable Fees. Individual expressly acknowledges and agrees that Provider may be a non-participating physician and thus, Individual is expressly requesting that Stitch Me Up and Providers provide non-participating/out-of-network Services and Individual will be responsible for payment of all applicable Fees. The Fees will not be considered a “Surprise Bill” under New York’s Emergency Medical Services and Surprise Bills law or analogous laws in other states.
Site Monitoring. I understand that Stitch Me Up may exercise its right to review, monitor, audit, intercept, and access all activity on the Site at any and all times, with or without notice, and Individual expressly consents to such monitoring. Any and all communications made utilizing the Site are the property of Stitch Me Up and may be reviewed by Stitch Me Up. Stitch Me Up may further revoke my access to the Site at any time.
Indemnity. Individual shall indemnify and hold Stitch Me Up and its Providers, employees, agents, and insurance companies harmless against all losses, liabilities, expenses (including, but not limited to, attorneys’ fees, expert fees, and court costs), fines or damages, whether direct or indirect, arising out of violation of the provisions of this User Agreement.
User Agreement Subject to Change. Stitch Me Up may modify the terms of this Agreement without prior notice.
Governing Law. This User Agreement is deemed to have been executed in the state of New York and shall be governed and construed in accordance with the laws of the State of New York without regard to or application of its conflicts of laws principles.
Supervening Circumstances. Stitch Me Up and its Providers will not be deemed in violation of this User Agreement if they are prevented from performing any of the Services or other obligations under this User Agreement by reason of: (a) severe weather and storms; (b) earthquakes or other natural occurrences; (c) strikes or other labor unrest; (d) power failures; (e) nuclear or other civil or military emergencies; (f) acts of legislative, judicial, executive, or administrative authorities; or (g) any other circumstances that are not within their reasonable control.
Attorney Fees/Costs. In the event there is a dispute brought in connection with the enforcement of this User Agreement, Individual will pay Stitch Me Up’s and Providers’ reasonable attorney fees, costs, and expenses.
Assignment. Individual may not assign this User Agreement or its obligations under it without the written consent of the Stitch Me Up.
No Construction Against Drafter. No entity or individual hereto will be considered to be the drafter of this User Agreement or any paragraph or term hereof and no presumption will apply to any Party as the “drafter.”
Amendment. This User Agreement may not be altered, amended, modified, or otherwise changed in any respect whatsoever except in writing, duly executed by an authorized representative of the parties.
Severability. If any term or other provision of this User Agreement is invalid, illegal or incapable of being enforced by any law or public policy, all other terms and provisions of this User Agreement shall nevertheless remain in full force and effect. Upon such determination that any term or other provision is invalid, illegal, or incapable of being enforced, the parties shall negotiate in good faith to modify this User Agreement so as to effect the original intent of the parties as closely as possible in an acceptable manner in order that the covenants contemplated by this User Agreement are consummated as originally intended to the greatest extent possible.
Survival. The obligations contained in this User Agreement shall be perpetual.
Acceptance of the User Agreement. Individual agrees that by electronically accepting the terms of this User Agreement by way of clicking on the “Accept” button, Individual has used an “Electronic signature” as defined in New York’s electronic signatures and records act. Individual further agrees that by clicking the “I agree to the User Agreement” button, Individual has knowingly and voluntarily executed this User Agreement with the intent to be bound by it.
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If you do not receive a call within 3 minutes please choose another surgeon or click empall to send out an emergency alert.
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Lacerations (cuts) occur every day as a result of falls, accidents and trauma. Plastic surgeons are skilled in repairing lacerations of the face, body and hands. Patients often present to the emergency room and request a plastic surgeon to close their wounds, particularly if it involves a child or the face since the outcomes are often superior. In addition, most emergency room physicians prefer to have the plastic surgeons involved since they are not technically trained to treat complex wounds in addition to being often time-constrained with a room full of patients.
The plastic surgeon "on call" is therefore called in to see the patient, however, they are often not immediately available and the whole event can take several hours. In addition, the call schedule changes regularly so patients never know whom they are going to get.
Improvements in smart phone technology have improved connectivity in the field of medicine, and todays patients prefer personalized care and the ability to participate in decision making. StitchMeUp © offers patients and providers the ability to locate a qualified plastic surgeon who is immediately available to meet patients in their office or the nearest emergency room. In addition, patients can preview their qualifications and read user-reviews to help them choose who they wish to help them. ALL of our surgeons our board-certified or board-eligible in the field of plastic/facial plastic surgery.
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BY USING OR OTHERWISE ACCESSING THIS WEBSITE, YOU AGREE TO TERMS OF THIS AGREEMENT. IF YOU DO NOT AGREE WITH THIS AGREEMENT, YOU CANNOT USE THE SITE.
IN THE EVENT OF AN EMERGENCY, PLEASE CALL 911 OR VISIT YOUR NEAREST EMERGENCY ROOM.
1. ABOUT THE SITE
Use of this website , including any text message sent to you because of information you provided to the Site, does not by itself, creates a patient-physician relationship between or among Stitch Me Up, any healthcare providers listed on the Site , and you.
2. CONTENT IS INFORMATIONAL RESOURCE
We make the Site available as a service to solely to assist you in finding a Provider that you may find suitable to meet your needs, and not for any other purpose. The Site may contain user-provided information (including information provided by Providers) (collectively, “Content”). Stich Me Up* cannot guarantee that the Content contained on the Site is accurate or complete, and it will not be responsible for any errors or omissions in the Content or for the results obtained from the use of such Content. All Content should be verified by you with any Provider, particularly in circumstances where you find the Content relevant to their selection of a particular Provider.
3. YOUR RESPONSIBILITIES
II) You will not use the Site or the Content for any purpose other than your own personal use as a patient or prospective patient.
(III) You will not use the Site, directly or indirectly, to engage in any anti-competitive, deceptive or unfair practices, or otherwise violate applicable antitrust, competition or consumer protection laws, or regulations.
4. CONTENT YOU POST OR SUBMIT.
You may have the opportunity to submit feedback regarding your experiences with Providers featured through the Site (collectively “User Content”).
By posting User Content through the Site, you agree to and hereby do grant, and you represent and warrant that you have the right to grant, to Stitch Me Up, its contractors and agents an irrevocable, perpetual, royalty-free, fully sublicensable, fully paid up, worldwide non-exclusive license to use, copy, publicly perform, digitally perform, publicly display, and distribute such User Content and to adapt, edit, translate, prepare derivative works of, or incorporate into other works, such User Content.
We reserve the right to publish your User Content and to also remove your User Content for any reason. We are not, however, responsible for any failure or delay in posting or removing User Content.
Keep in mind that the User Content of others is simply opinion and should not be relied on. Without limiting the generality of the foregoing:
- You are solely responsible for any User Content that you submit, publish or display through the Site or transmit to other members and/or other users of the Site.
- You may not post, distribute, or reproduce in any way any copyrighted material, trademarks, or other proprietary information without obtaining the prior written consent of the owner of such proprietary rights. You may not submit any content or material that infringes, misappropriates or violates the intellectual property, publicity, privacy or other rights of any party.
- You may not provide any User Content that is unlawful or that promotes or encourages illegal activity.
- You understand and agree that Stich Me Up may (but is not obligated to) review and delete any User Content that in the sole judgment of Stich Me Up violates these terms or which might be offensive, illegal, or that might violate the rights of, harm, or threaten the safety of other Site users or Providers.
- You agree that you will only provide User Content that you believe to be true.
- You may not submit User Content that:
- is false, deceptive or misleading;
- harasses or advocates harassment of another person;
- violates, infringes or misappropriates the intellectual property or other rights of any person;
- violates antitrust, competition, or consumer protection laws;
- is threatening, abusive, obscene, defamatory or libelous; or
- is pornographic or sexually explicit in nature.
The foregoing is a partial list of the kind of content and communications that are illegal or prohibited on/through the Site.
5. RESTRICTED USES
You agree not to use the Site in any unlawful, infringing, tortious or harmful manner; in any way that violates another party’s intellectual property, privacy or other rights; or in any way that otherwise interferes with the operation, use or enjoyment of any service, system or other property. Without limiting any of the foregoing, you agree that you shall not (and you agree not to allow any third party to):
- copy, modify, adapt, translate, or reverse engineer any Content or portion of the Site or its content;
- remove any copyright, trademark or other proprietary rights notices contained in or on the Site or in or on any Content;
- use any robot, spider, site search/retrieval application, or other automated device, process or means to access, retrieve or index any portion of the Site;
- access or retrieve any Content or portion of the Site for purposes of constructing or populating a searchable database of reviews or other Content related to the healthcare industry or Providers;
- reformat or frame any Content or portion of the web pages that are part of the Site;
- create user accounts, book appointments or submit User Content by automated means or under false or fraudulent pretenses;
- collect or store personal data about other users in connection with the prohibited activities described in this paragraph; or
- use any means, including software means, to conduct web scraping of any portion of the Site or its content.
6. YOUR USE OF CONTENT
All of the Content is owned by us or our licensors and is protected by copyright, trademark, patent, and trade secret laws, other proprietary rights, and international treaties. You acknowledge that the Site and any underlying technology or software used in connection with the Site contain Stitch Me Up’s proprietary information. We give you permission to use the aforementioned content for personal, non-commercial purposes only and do not transfer any intellectual property rights to you by virtue of permitting your use of the Site. You may print, download, and store information from the Site for your own convenience, but you may not copy, distribute, republish (except as permitted in this paragraph), sell, or exploit any of the content, or exploit the Site in whole or in part, for any commercial gain or purpose whatsoever. Except as expressly and unambiguously provided herein, neither Stitch Me Up nor its suppliers grant you any express or implied rights, and all rights in the Site not expressly granted by Stitch Me Up to you are retained by Stitch Me Up.
7. DISCLAIMER OF WARRANTIES
We have no special relationship with or fiduciary duty to you. You release us from all liability for you having acquired or not acquired content through the Site. We make no representations or warranties regarding suggestions or recommendations of services or products offered or purchased through the Site. WE PROVIDE THE SITE “AS IS”, “WITH ALL FAULTS” AND “AS AVAILABLE.” WE DO NOT GUARANTEE THAT YOU WILL BE ABLE TO ACCESS OR USE THE SITE (EITHER DIRECTLY OR THROUGH THIRD-PARTY NETWORKS) AT TIMES OR LOCATIONS OF YOUR CHOOSING. WE ARE NOT RESPONSIBLE FOR THE ACCURACY, RELIABILITY, TIMELINESS OR COMPLETENESS OF INFORMATION PROVIDED BY USERS OF THE SITE OR ANY OTHER DATA OR INFORMATION PROVIDED OR RECEIVED THROUGH THE SITE. EXCEPT AS EXPRESSLY SET FORTH HEREIN, STITCH ME UP MAKES NO WARRANTIES ABOUT THE INFORMATION SYSTEMS, SOFTWARE AND FUNCTIONS MADE ACCESSIBLE THROUGH THE SERVICES, INCLUDING ANY TEXT MESSAGE SENT TO YOU BECAUSE OF INFORMATION YOU PROVIDED TO THE SITE OR ANY OTHER SECURITY ASSOCIATED WITH THE TRANSMISSION OF SENSITIVE INFORMATION. STITCH ME UP DOES NOT WARRANT THAT THE SITE WILL OPERATE ERROR-FREE, BUG-FREE OR FREE FROM DEFECTS, THAT LOSS OF DATA WILL NOT OCCUR, OR THAT SOFTWARE OR SITE ARE FREE OF COMPUTER VIRUSES, CONTAMINANTS OR OTHER HARMFUL ITEMS.
8. GENERAL LIMITATION OF LIABILITY
YOU AGREE THAT IN NO EVENT SHALL WE HAVE ANY LIABILITY TO YOU FOR ANY AND ALL CLAIMS RELATING TO OR ARISING OUT OF YOUR USE OF THE SITE, REGARDLESS OF THE FORM OF ACTION AND YOU HEREBY FULLY AND COMPLELTLY RELEASE US FROM ANY AND ALL CLAIMS, WHETHER ACCRUED OR UNACCRUED, KNOWN OR UNKNOWN, RELATING TO OR ARISING OUT OF YOUR USE OF THE SITE
Upon a request by us, you agree to defend, indemnify, and hold harmless us, our employees, contractors, officers, directors, agents, parent, other affiliated companies, suppliers, successors, and assigns from all liabilities, claims, demands and expenses, including attorney’s fees, made by any third party that arise from or are related to (a) your access to or use of the Site, or (b) violation of this Agreement. The foregoing indemnification obligation does not apply to liabilities, claims and expenses arising as a result of our own gross negligence or intentional misconduct.
B. Limitation of Claims
No action arising under or in connection with this Agreement, regardless of the form, may be brought by you more than one (1) year after the cause of action arose; actions brought thereafter are forever barred.
C. Choice of Law;Arbitration Clause and Class Action Waiver – Important – Please Review as This Affects Your Legal Rights
This Agreement shall be deemed to have been entered into and shall be construed and enforced in accordance with the laws of the State of New York as applied to contracts made and to be performed entirely within New York, without giving effect to the state’s conflicts of law statute. YOU AGREE THAT ALL DISPUTES BETWEEN YOU AND US (WHETHER OR NOT SUCH DISPUTE INVOLVES A THIRD PARTY) WITH REGARD TO YOUR RELATIONSHIP WITH US, INCLUDING WITHOUT LIMITATION DISPUTES RELATED TO THIS AGREEMENT, YOUR USE OF THE SITE, AND/OR RIGHTS OF PRIVACY AND/OR PUBLICITY, WILL BE RESOLVED BY BINDING, INDIVIDUAL ARBITRATION UNDER THE AMERICAN ARBITRATION ASSOCIATION’S RULES FOR ARBITRATION OF CONSUMER-RELATED DISPUTES AND YOU AND WE HEREBY EXPRESSLY WAIVE TRIAL BY JURY. Neither you nor we will participate in a class action or class-wide arbitration for any claims covered by this Agreement to arbitrate. YOU ARE WAIVING THE ABILITY TO PARTICIPATE AS A CLASS REPRESENTATIVE OR CLASS MEMBER ON ANY CLASS CLAIM YOU MAY HAVE AGAINST US INCLUDING ANY RIGHT TO CLASS ARBITRATION OR ANY CONSOLIDATION OF INDIVIDUAL ARBITRATIONS. You also agree not to participate in claims brought in a private attorney general or representative capacity, or consolidated claims involving another person’s account, if we are a party to the proceeding. This dispute resolution provision will be governed by the Federal Arbitration Act and not by any state law concerning arbitration. Judgment on the award rendered by the arbitrator may be entered in any court having competent jurisdiction. Any provision of applicable law notwithstanding, the arbitrator will not have authority to award damages, remedies or awards that conflict with these Terms of Service.
* Stitch Me Up means 112 NY Medical, PLLC, a New York professional limited liability company, d/b/a Stitch Me Up, or its affiliates.
Community Health Plans (CHP), 1199, Medicare and Medicaid Plans are NOT accepted