SeaGlow Aesthetics, LLC · Rebecca Negrón, M.D. · St. Petersburg / Tampa Bay, Florida
Mobile Concierge & Telehealth Aesthetics and Wellness Services — St. Petersburg & Tampa Bay, Florida
This Membership Agreement (“Agreement”) is entered into between SeaGlow Aesthetics, LLC, a Florida limited liability company (“SeaGlow,” “we,” “us,” or “our”), and the individual identified below (“Member,” “you,” or “your”). This Agreement governs your enrollment in a SeaGlow membership tier and your receipt of related aesthetic, wellness, and medical services. By signing below, you agree to the terms of this Agreement in their entirety.
SeaGlow offers three (3) membership tiers, described in full below. Each tier is offered on an initial committed term of either six (6) months or twelve (12) months, as selected by Member at enrollment; the same term length applies for the duration of that commitment regardless of tier. Member selects one tier and one term length at enrollment and may change tiers as described in Section 4. All services and benefits are provided directly by or under the supervision of Rebecca Negron, M.D. (“Dr. Negron”), a Florida-licensed physician (License No. ME126702), or by SeaGlow personnel acting within their scope of practice and under Dr. Negron's supervision.
| Feature | GLOW — Aesthetics $99/month | RADIANCE — Wellness $149/month | LUMINOUS — Medical $199/month |
|---|---|---|---|
| Service discount | 10% off all services | 15% off all services | 20% off all services |
| Monthly injection / add-on | 1 complimentary BFA or BFAP add-on per month | 1 B12 or MIC injection per month | 1 B12 or wellness injection per month |
| Provider visits | Priority booking access | Quarterly physician appointment with basic labs and review | Monthly provider check-in (in-home or telehealth) with lab review as needed |
| Telehealth | Free telehealth visits | Free telehealth follow-ups; written prescription included | Free telehealth follow-ups; written prescription included |
| Fees waived | — | Lab processing fee waived | Lab processing fee and mobile visit fee waived |
| Monthly fee | $99.00 | $149.00 | $199.00 |
Member acknowledges that the total committed-term obligation equals the monthly fee for the selected tier multiplied by the number of months in the selected term (e.g., a 12-month LUMINOUS commitment totals $2,388.00), billed monthly as described in Section 4, and that early termination obligates Member to pay the remaining unbilled balance as described in Section 5.
Membership is a direct-pay arrangement for the access, discounts, and bundled services described in Section 1. Membership is not health insurance, does not satisfy any individual or employer health insurance mandate, and does not provide coverage for services rendered by any other provider or facility.
Membership fees are not eligible for reimbursement from any third-party payer, including Medicare or Medicaid, except that Member may independently seek reimbursement of eligible expenses through a Health Savings Account (HSA) or Flexible Spending Account (FSA) where permitted; Member is solely responsible for determining eligibility and for any required substantiation.
Add-on services, products, retail items, and procedures beyond those expressly bundled into the selected tier are billed separately at SeaGlow's then-current rates, less the applicable membership discount.
Unused monthly benefits (including the complimentary BFA/BFAP add-on, B12/MIC injection, or provider check-in) do not roll over to a subsequent month and have no cash value.
Enrollment in a SeaGlow membership establishes or continues a physician-patient relationship with Dr. Negron and does not, by itself, guarantee any specific diagnosis, treatment outcome, or eligibility for any particular prescription medication. All clinical decisions, including prescribing, remain within Dr. Negron's independent medical judgment in accordance with the applicable standard of care.
Telehealth visits included with membership are provided in accordance with Florida law governing telehealth, including the Florida Telehealth Act (Chapter 456, Part XIII, Florida Statutes). Member acknowledges that telehealth has inherent limitations compared to an in-person examination and consents to receive care by telehealth where clinically appropriate, as determined by Dr. Negron.
Any prescriptions issued under RADIANCE or LUMINOUS tiers are issued only where medically appropriate following examination, telehealth evaluation, and/or review of labs, and are subject to applicable Florida and federal prescribing laws, including requirements applicable to controlled substances and compounded medications. SeaGlow operates on a prescribe-only model and does not dispense medication on-site; prescriptions are filled through licensed, appropriately permitted pharmacies.
Member will be asked to execute a separate Informed Consent for Telehealth Services and, where applicable, Informed Consent for Compounded Medications prior to receiving those services. Those consents are incorporated into this Agreement by reference.
(a) Initial Committed Term. This Agreement begins on the Start Date and continues for the initial committed term selected by Member in Section 1 (six (6) or twelve (12) consecutive monthly billing cycles). The selected term length applies regardless of which membership tier Member chooses.
(b) Recurring Billing. Membership fees are billed automatically in advance on the same calendar day of each month as the Start Date, to the payment method Member provides at enrollment. This is a recurring charge; Member expressly authorizes SeaGlow to charge the designated payment method each billing cycle for the duration of the committed term described in Section 4(a) and, thereafter, the month-to-month period described in Section 4(d), until the Agreement is terminated in accordance with Section 5. Member's monthly rate is fixed and will not increase during the initial committed term.
(c) Failed Payment. If a scheduled payment fails, SeaGlow will attempt to notify Member and may suspend membership benefits until the outstanding balance is resolved. Failure to resolve an outstanding balance within fifteen (15) days after notice does not relieve Member of the remaining committed-term balance described in Section 5(b); SeaGlow may pursue collection of that balance in addition to suspending or terminating benefits.
(d) End of Committed Term; Conversion to Month-to-Month. Unless Member affirmatively elects a new committed term by written or electronic notice at least thirty (30) days before the current committed term ends, this Agreement automatically converts to a month-to-month membership, at Member's then-current tier and SeaGlow's then-current month-to-month rate for that tier, upon completion of the committed term. Once converted, Member may cancel at any time as described in Section 5(c), with no further commitment or early-termination obligation.
(e) Tier Changes. Member may upgrade to a higher membership tier at any time, effective on the next billing cycle, by providing notice at least five (5) business days before the next billing date, using the same contact method used to enroll (email, patient portal, or written notice); the higher tier's monthly rate applies for the remainder of the then-current term. Downgrades to a lower tier may not be made during an active committed term but may be elected at the time of renewal or once the membership has converted to month-to-month under Section 4(d).
(f) Price Changes. Pricing is fixed for the duration of an active committed term and will not change under this subsection while that term is in effect. For a subsequent committed term or for month-to-month service following conversion under Section 4(d), SeaGlow may adjust pricing or benefits with at least thirty (30) days' advance written or electronic notice; continued payment after the effective date of such a change constitutes acceptance, and Member may instead cancel under Section 5 before the change takes effect.
(a) Right to Cancel Within Three (3) Business Days. Member may cancel this Agreement for any reason, without penalty, within three (3) business days of signing (excluding Sundays and legal holidays), by delivering written notice to SeaGlow at the contact information in Section 12. Upon timely cancellation under this subsection, SeaGlow will refund any amounts already paid in full within thirty (30) days, less the reasonable value of any services already actually rendered to Member.
(b) Early Termination During the Committed Term. After the three-business-day period in Section 5(a), if Member terminates this Agreement before completing the selected committed term for any reason other than those described in Section 5(d), Member remains responsible for the remaining unbilled balance of the committed term — the monthly rate for Member's tier multiplied by the number of full months remaining in the term — due immediately upon cancellation. This amount reflects the parties' reasonable pre-estimate of SeaGlow's lost revenue from early termination of a committed-term membership and is not a penalty.
(c) Cancellation After the Committed Term (Month-to-Month). Once this Agreement has converted to month-to-month service under Section 4(d), Member may cancel at any time, effective at the end of the then-current paid billing cycle, by providing written or electronic notice (email or patient portal message satisfies this requirement) at least five (5) business days before the next scheduled billing date, with no early-termination balance owed. Member may cancel using the same method used to enroll and is not required to call or appear in person to cancel.
(d) Medical Inability or Relocation. If Member becomes medically unable to use membership services (supported by documentation from a treating provider) or permanently relocates more than fifty (50) miles outside SeaGlow's Tampa Bay service area, Member may cancel immediately upon notice, owes no remaining committed-term balance under Section 5(b), and will receive a pro-rata refund of any prepaid, unused portion of the then-current billing cycle within thirty (30) days of notice.
(e) SeaGlow's Right to Terminate. SeaGlow may terminate this Agreement immediately if, in Dr. Negron's professional judgment, continued treatment is not clinically appropriate or safe for Member, or if Member engages in abusive, unsafe, or fraudulent conduct. SeaGlow will provide reasonable notice and assistance identifying alternative care where required by applicable standards governing termination of the physician-patient relationship. If SeaGlow terminates under this subsection for reasons not attributable to Member's conduct, Member owes no remaining committed-term balance and will receive a pro-rata refund of any prepaid, unused portion of the then-current billing cycle within thirty (30) days.
Member must be at least eighteen (18) years of age to enroll. Member represents that all health history, medication, and allergy information provided to SeaGlow is accurate and complete and agrees to promptly update SeaGlow of any changes.
Certain services (including neuromodulators, dermal fillers, B12/MIC injections, Battlefield Acupuncture, and prescription medications) carry inherent risks. Member will be provided procedure- and medication-specific informed consent documentation before receiving such services, and no service will be performed without Member's informed consent.
The service discount associated with Member's tier (10%, 15%, or 20%, as applicable) applies to SeaGlow's then-current menu of aesthetic and wellness services and does not apply to product/retail purchases, third-party fees (such as compounding pharmacy or laboratory charges not otherwise waived under Member's tier), or services already discounted or promotional.
Membership discounts and benefits are personal to Member, are non-transferable, and may not be combined with other promotional offers unless SeaGlow expressly states otherwise in writing.
SeaGlow maintains the privacy of Member's protected health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and Florida law. SeaGlow's Notice of Privacy Practices, provided separately, is incorporated into this Agreement by reference and describes how Member's health information is used, disclosed, and protected.
Member acknowledges that mobile, in-home, and telehealth visits involve the transmission and storage of health information through SeaGlow's electronic health record and telehealth platforms, which SeaGlow has selected for HIPAA-compliant data handling.
Nothing in this Agreement limits or waives any claim for professional negligence or medical malpractice, which remains governed by Florida law, including Chapter 766, Florida Statutes. This Agreement does not constitute, and may not be construed as, a waiver of Member's right to bring a claim for the negligent provision of medical care.
To the fullest extent permitted by law, SeaGlow's liability for non-medical, contractual matters arising from this Agreement (such as billing disputes) is limited to the amount of membership fees paid by Member in the twelve (12) months preceding the claim.
This Agreement is governed by the laws of the State of Florida, without regard to conflict-of-laws principles. Venue for any dispute arising under this Agreement (other than a medical malpractice claim, which is governed by Chapter 766, Florida Statutes) lies exclusively in the state or federal courts located in Pinellas County, Florida.
Before filing suit on a billing or contractual dispute (excluding malpractice claims), the parties agree to attempt good-faith informal resolution by contacting SeaGlow directly at the information in Section 12.
This Agreement, together with SeaGlow's Notice of Privacy Practices, applicable informed consent forms, and the membership pricing referenced in Section 1, constitutes the entire agreement between Member and SeaGlow regarding membership services and supersedes any prior oral or written representations. This Agreement may be amended by SeaGlow as described in Section 4(e); all other amendments must be in writing and signed by both parties.
If any provision of this Agreement is held unenforceable, the remaining provisions remain in full force and effect.
SeaGlow Aesthetics, LLC — Rebecca Negron, M.D.
St. Petersburg / Tampa Bay, Florida
Website: seaglowaesthetics.com | Instagram: @seaglow_aesthetics
Written notices under this Agreement (including cancellation notices) should be sent to the practice address and email provided to Member at enrollment, or delivered via SeaGlow's secure patient portal.
By checking the box below and continuing to payment, Member acknowledges that they have read this Agreement in its entirety, have had the opportunity to ask questions, understand its terms, and voluntarily agree to be bound by it, including the automatic monthly billing described in Section 4 and the cancellation procedure described in Section 5. This electronic acknowledgment has the same force and effect as a handwritten signature.
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