Written Information for Patients

The following information is to be provided in written form to all patients to whom you offer arbitration:

1. Once the arbitration agreement is signed, all disputes will be decided through the arbitration process rather than by a judge or jury;
2. Arbitrators are individuals who are chosen to resolve disputes. The patient selects and arbitrator, the physician selects an arbitrator, and the physician and patient agree on a third arbitrator selected from a list of individuals approved as arbitrators or mediators by the state or federal courts;
3. The patient pays the fees of his or her arbitrator, the physician pays the fess of his or her arbitrator, and the patient and the physician share the fees of the third arbitrator;
4. The patient has the right to rescind the arbitration agreement for 10 days after the date it is signed;
5. The arbitration agreement automatically renews each year unless it is cancelled in writing before the renewal date; and
6. The patient has the right to have questions answered about the arbitration agreement.