Voluntary Arbitration Agreement
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How to draft a proper Voluntary Arbitration Agreement? Download this Voluntary Arbitration Agreement template that will perfectly suit your needs!
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2355 Dougherty Ferry Road Suite 430 St. Louis Missouri 63122 P: 314-965-8410 F: 314-965-8756 www.stllapband.com AGREEMENT For and in consideration of the medical care and services provided by insert name of physician and the agents, employees, associates, staff members, partners, officers, directors, shareholders, proprietors or equity owners of insert name of medical entity providing medical services (collectively referred to as the “Provider”) to the undersigned, the undersigned agrees that in the event there shall be a claim, dispute or disagreement pertaining to the provision of medical care, or lack of medical care, including any claim of negligence (meaning the failure to use that degree of skill and learning ordinarily used under the same or similar circumstances by the members of Provider’s profession) by or on behalf of Provider or any agent, employee, associate, staff member, partner, officer, director, shareholder, proprietor or equity owner of Provider, the undersigned agrees that in such event: (i) prior to making any claim against Provider or any person included within the term Provider, the undersigned shall obtain a signed affidavit from a Missouri-licensed medical doctor practicing and board certified in the subspecialty of the medical services which are the subject of the claim, stating that the Provider was negligent (as defined above) in providing medical care, and deliver such affidavit to Provider, and (ii) each and every expert witness testifying in any proceeding on the undersigned’s behalf shall be a Missouri-licensed medical doctor practicing and board certified in the subspecialty of the medical services which are the subject of the claim..
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