The short version

You’re hiring SurgiQuality to act as your authorized representative and chase your medical records from the providers you identify. This is a concierge service — you’re paying for our effort and the fees we pay your providers on your behalf, not a guaranteed result.

The detailed terms below are what govern. If anything in the summary above conflicts with the detailed terms, the detailed terms control.

1. Who this agreement is between

This Concierge Records Service Agreement (“Agreement”) is between SurgiPrice, Inc., doing business as SurgiQuality (“SurgiQuality,” “we,” “us”), and you, the patient (or the patient’s legally authorized representative) named at the time of payment.

This Agreement supplements but does not replace your SurgiQuality Terms of Service (linked at the bottom of this page) and your HIPAA Release for the procedure(s) you’ve asked us to assist with. Those documents continue to govern.

2. What we’ll do (Service Scope)

2.1 Identify and contact your providers

Based on the list of providers, facilities, and dates of care you give us, we will identify the medical records, imaging, and reports relevant to your procedure and submit requests to each provider on your behalf as your authorized representative under HIPAA.

2.2 Submit HIPAA-authorized requests

We will use the per-procedure HIPAA Release you signed with us — or, if a provider requires its own form, we will route that form to you for signature and submit it.

2.3 Pay provider copy fees

Many providers charge a small fee for releasing records. We will pay these fees on your behalf up to $50 per provider as part of this service. If a single provider’s fee exceeds $50, we will ask you to approve and cover the additional amount before paying.

2.4 Follow up

We will follow up with each provider by phone, fax, secure email, or portal every 5–7 business days until your records arrive or until the provider definitively declines or fails to respond within a reasonable time.

2.5 Arrange imaging transfer

For imaging studies, we will arrange transfer of DICOM files via secure upload, image-sharing networks, or physical media (CD/DVD) as appropriate.

2.6 Organize for your reviewing surgeons

When records arrive, we will organize them for the independent surgeons who will be reviewing your case — chronologically, by record type, and indexed for easy review.

3. What you’ll do (Patient Cooperation)

Your active cooperation is essential. Without it, we cannot perform this service. By purchasing this service you agree to:

3.1 Provide a complete provider list

Identify every hospital, clinic, surgeon’s office, imaging facility, and lab where you received care related to the procedure. You know your providers; we do not.

3.2 Respond within 3 business days

When we have a question, need clarification, or need you to sign a provider-specific form, you will respond within 3 business days. Failure to respond stalls the service.

3.3 Sign any provider-specific authorizations

Some providers require their own authorization form rather than accepting our HIPAA Release. When this happens, we will send the form to you. You will sign and return it within 3 business days.

3.4 Cover provider fees over $50

If a single provider charges more than $50 for record copies, we will tell you the amount and ask you to cover the additional cost. We will not pay over $50 per provider without your authorization.

3.5 Tell us about new providers as you remember them

If you remember an additional provider after the service has started, tell us as soon as possible.

4. The fee, and why it’s non-refundable

The Concierge Records Service fee is $149.00 USD per procedure, paid one-time at the start of the service.

You are paying for our effort and the costs we incur on your behalf, not for a guaranteed outcome.

5. Timeline and abandonment

5.1 When we start

We will begin work within 1 business day of receiving your payment and provider list.

5.2 Typical completion window

Most providers respond within 14–30 days. We will use reasonable, persistent effort for up to 60 calendar days after the start date. If records are still outstanding at day 60, we will give you a status report and discuss next steps with you.

5.3 If you go silent

See Section 3.5. If 14 consecutive days pass with no response from you, the service closes. No refund.

5.4 If a provider definitively refuses

Some providers refuse to release records even with valid HIPAA authorization. When this happens, we will tell you, advise on options (including filing a complaint with the U.S. Department of Health and Human Services Office for Civil Rights), and continue working on your other providers.

6. What we can’t promise

• That every provider will respond to our requests.
• That every record we request will be located by the provider.
• That records will arrive by any specific date.
• That records will be complete, legible, or fully formatted.
• That a provider will accept our HIPAA Release rather than insisting on its own form.
• That a provider’s copy fee will be at or below $50.
• That we will succeed in the face of provider non-response, refusal, system failure, or other circumstances outside our control.

7. Your right to cancel

You may cancel this service at any time by emailing [email protected]. Upon cancellation:

• We will stop submitting new record requests.
• We will deliver any records collected up to the cancellation date.
• The $149 fee is not refunded.

8. Privacy and security

Your medical records are handled under the privacy and security commitments stated in our Terms of Service and HIPAA Release. We use encrypted transmission and storage, role-based access limited to your concierge and your reviewing surgeons, and we do not sell, rent, or use your records for marketing purposes.

9. Limitation of liability

Our total liability to you under this Agreement is limited to the amount you paid for the service. We are not liable for (a) provider non-response, (b) inaccurate records released by providers, (c) delays caused by you, your providers, or events outside our reasonable control, or (d) consequential, indirect, or special damages of any kind.

This limitation does not apply to liability that cannot be limited by law.

10. Governing law and disputes

This Agreement is governed by the laws of the State of Texas, without regard to its conflict of laws principles. Any dispute will be resolved through binding arbitration administered by the American Arbitration Association under its Consumer Arbitration Rules, with arbitration held in Harris County, Texas.

Nothing in this section prevents you from filing a complaint with the U.S. Department of Health and Human Services Office for Civil Rights regarding a provider’s HIPAA compliance.

11. How you accept this agreement

You accept this Agreement when you check the Terms of Service box on the Stripe payment page and complete payment of $149.00. Your checkout receipt and the Stripe consent record together form the executed Agreement.