Acceptance of Terms, Conditions, and Disclaimer
I am choosing to have my imaging study read by a Your 2nd Look LLC licensed US radiologist or US cardiologist for the sole purpose of reviewing the image and providing a report based thereon. I understand that doing so will not establish a doctor/patient relationship between myself and the radiologist. I will not be receiving treatment advice from the company or its radiologists and cardiologists, and I must still seek the advice of my primary healthcare provider. I agree to read the report prepared for me in full upon receipt. If the report includes a finding of a critical condition I understand I will be notified about the relevant condition and that I should immediately contact my treating physician. I authorize the reading Your 2nd Look radiologist to contact my physician in such case in compliance with procedural guidelines. I am not requesting the report for the purposes of litigation, pending or planned and understand that the company’s radiologists will not testify in any such matter. The company reserves the right to not issue a report for images which it believes have observable flaws or defects. In such case, I will be issued a full refund for payment made and notified of the problem with the image.

I am paying Your 2nd Look LLC for the services provided in accordance with the posted fee schedule subject to any applicable discounts offered by the company. I understand that it is likely that this payment will not be reimbursed by Medicare, Medicaid or any private insurance plan and will be a personal out of pocket expense.

I understand that in the event that Your 2nd Look if for any reason stated or otherwise cannot provide me services due to poor image quality or an unserviceable U.S. State in which i reside for example, that i will be refunded fully within a period of 10 days, not to exceed the initial charges.

I understand that Your 2nd Look operates in full compliance with HIPAA requirements concerning patient privacy and that its website conforms to applicable security and privacy standards.

By checking the box below I accept all of the all of the terms and conditions set forth above, represent that I am fully authorized to order this report if I am not the patient, and will proceed to the payment portion of the website to place and complete my order.