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Web-Identities^® connects physicians and patients.
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Contact Information

Name

First		Last

Company

Postal Address

Postal Address (Line 2)

City

State (US Only)

Province (Outside US)

Zip Code

Telephone

Alternate Telephone

Fax

E-Mail Address

Business Information

Type of Medical Office
City Location

Terms of Service Agreement

I understand that charges will be billed to my account at the beginning of the billing cycle along with any additional usage fees from the prior period. I understand that I may cancel my account at any time effective the end of that billing cycle. If I am not satisfied and wish to cancel my account within 30 days of the day Web-Identities.net activates my account, I may do so and receive a full refund of all money paid, except for Web-Identities' setup fees and any other charges and registration fees associated with initial registration and setup. I understand that Web-Identities.net may change its prices from time to time, and that I will be provided with 30 days electronic mail notice of any such changes. I agree that the information provided in my website will be my responsibility. The content of the site is to both educate current patients and to attract new patients. Please note that the information on your website is not intended as medical advice. For questions about how to treat an illnesses, patients are always encouraged to consult a physician. I specifically agree not to make any attempt to gain unauthorized access to any systems or networks. I understand that the information available through Web-Identities.net or interconnecting networks may not be accurate. I understand that internetworking communications are not secure, and may be subject to interception or loss. Unless you specifically request 128-bit internet security, your website privacy will not comply with HIPPA patient privacy policies. Web-Identities.net does not recommend using non-secure email access for patient communication. Web-Identites.net does not makes no warranties of any kind, either express, implied, or statutory concerning the data or information available through the the website we design for you. I understand that the use of my website, and any data or information accessed using that site, will be completely at my own risk. I understand that the cumulative liability of Web-Identities.net for any and all claims relating to the services provided by Web-Identities.net, in contract, tort, or otherwise, shall not exceed the total amount of the basic service fees paid to Web-Identities.net for services within the prior year. I agree that Web-Identities.net shall have no liability for the services, data or information made available to me, including any liability for any consequential, indirect, special or incidental damages regardless of the success or effectiveness of other remedies. I understand that Web-Identities.net reserves the right to terminate my account at any time, for any reason, including, but not limited to, my failure to abide by the terms of this agreement or my failure to pay any fees or charges when due. I understand that violation of certain generally accepted guidelines on Internet usage, such as restrictions on mass e-mailings and mass advertising, or posting to inappropriate newsgroups, may cause severe operating difficulties for Web-Identities.net, and would be a likely cause for the termination of my account. This agreement represents the complete agreement between Web-Identities.net, and myself, and supersedes any other written or oral agreement. The terms of this agreement may only be changed in writing and any changes must be signed by both Web-Identities.net and myself to be effective.

I have read, understand and agree to the above terms.

PBS Publishing, LLC
866-422-0554 - Toll Free Number

CompanyFAX - Fax

CompanyEmail - Information

support@web-identities. net