Welcome to the Credit Card Payment Authorization (“Authorization”) for David Lechnyr, LCSW (“I” or “me” or “my”). I provide appointments for therapy and coaching services for those interested in making changes to their lives (“Users” or “User”) through online scheduling and reserving the appointment using a card-on-file option (“Card on File Service”).
These terms are between you, the User, and myself, David Lechnyr, LCSW, and govern my respective rights and obligations. I encourage you to carefully read, understand and ask your questions about these Authorization.
To use the Card on File Service, you, the User, must schedule an appointment and reserve the appointment by adding a card on file to the Card on File Service. Adding a card on file to the Card on File Service creates an active “Card Profile.”
Acceptance to Terms
If you create a Card Profile, you accept these terms, conditions, limitations and requirements. your use of the Card on File Services are also governed by other applicable terms, conditions, limitations and requirements of the Card on File Service, all of which (as changed over time) are incorporated into these terms. If you do not agree to these Authorization, do not use the Card on File Service and do not create a Card Profile.
Agreement to Changes
I may at my discretion change this Authorization, or any aspect of the Card on File Service, without notice to you. If any change to these terms is found invalid, void, or for any reason unenforceable, that change is severable and does not affect the validity and enforceability of any remaining changes or conditions. YOUR CONTINUED USE OF THE CARD ON FILE SERVICE AFTER I CHANGE THESE TERMS CONSTITUTES YOUR ACCEPTANCE OF THE CHANGES. IF YOU DO NOT AGREE TO ANY CHANGES, YOU MUST CANCEL YOUR CARD PROFILE.
Informed Consent for use of Card on File Services and Payment Authorization
UPON CREATING A CARD PROFILE YOU CONSENT AND AUTHORIZE ME TO USE YOUR CARD PROFILE TO CHARGE YOUR CARD, WHETHER THAT BE A CREDIT, DEBIT, HSA OR FSA CARD, THE COST OF MY SERVICES FOR PAYMENT OF PROVIDED SERVICES AS REQUIRED BY MY CLIENT AGREEMENT AND INFORMED CONSENT (“PRACTICE POLICIES”). MY PRACTICE POLICIES OUTLINE THE AGREED AMOUNTS FOR MY SERVICES. MY PRACTICE POLICIES ARE THEREBY INCORPORATED BY REFERENCE AND ATTACHED TO THIS AUTHORIZATION.
UPON CREATING A CARD PROFILE YOU FURTHER UNDERSTAND THAT THIS AUTHORIZATION OF ME TO CHARGE YOUR CARD PROFILE WILL REMAIN IN EFFECT UNTIL YOU CANCEL YOUR CARD PROFILE AND YOU FURTHER AGREE TO NOTIFY ME OF SUCH CANCELLATION BEFORE YOUR NEXT SCHEDULED DATE OF MY SERVICES.
UPON CREATING A CARD PROFILE YOU CONSENT TO HAVE YOUR CARD KEPT ON FILE WITH THE CARD ON FILE SERVICE AS AN ELIGIBLE PAYMENT METHOD I HAVE ON RECORD FOR YOU.
UPON A CHARGE BY ME, YOU AGREE TO PAY THE CHARGED TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT.
YOU CERTIFY THAT YOU ARE AN AUTHORIZED USER OF THE CARD YOU ADD TO YOUR ACTIVE CARD PROFILE AND WILL NOT DISPUTE THE CHARGES MADE BY ME ACCORDING TO THIS AUTHORIZATION WITH YOUR BANK OR CREDIT CARD COMPANY, SO LONG AS THE TRANSACTIONS CORRESPOND TO THIS AUTHORIZATION TO WHICH YOU CONSENT AND UNDERSTAND YOU HAVE AUTHORIZED BY CREATING A CARD PROFILE.
YOU UNDERSTAND THAT I DO NOT NEED ANY ADDITIONAL CONSENT BY YOU, THE USER, WHETHER YOU ARE THE USER OF MY SERVICES OR THE RESPONSIBLE PAYOR TO THE USER OF MY SERVICE, TO MAKE A CHARGE OR REFUND A CHARGE TO YOUR ACTIVE CARD PROFILE. FOR PURPOSE OF CLARITY, YOU AGREE THAT NO PRIOR-NOTIFICATION OF CHARGES WILL BE PROVIDED.
YOU UNDERSTAND THAT MY PRACTICE POLICIES INCLUDES LATE CANCELLATION FEES AND NO-SHOW FEES THAT DO NOT REQUIRE ANY ADDITIONAL CONSENT BY YOU, THE USER, TO MAKE A CHARGE TO YOUR ACTIVE CARD PROFILE.
UNLESS YOU NOTIFY ME BEFORE A CHARGE THAT YOU WANT TO CANCEL, YOU UNDERSTAND AND AUTHORIZE ME TO MAKE CHARGES AND ME (WITHOUT NOTICE TO YOU, UNLESS REQUIRED BY APPLICABLE LAW) TO COLLECT THE THEN-APPLICABLE FEE, PER MY REQUEST AND ANY TAXES, USING YOUR ACTIVE CARD PROFILE, OR ANY ELIGIBLE PAYMENT METHOD I HAVE ON RECORD FOR YOU.
YOU UNDERSTAND THAT YOUR CREATION OF A CARD PROFILE INDICATES THAT YOU ARE AWARE THAT YOU WILL RECEIVE TEXT MESSAGES FROM A CARD PROCESSING SYSTEM AND YOU CONSENT TO RECEIVING TEXT MESSAGE FROM THE CARD PROCESSING SYSTEM. YOU UNDERSTAND THAT IN ORDER TO FACILITATE YOUR ACTIVE CARD PROFILE, THE CARD PROCESSING SYSTEM MAY SEND YOU EMAILS AND/OR TEXT MESSAGES SUCH AS CHARGE CONFIRMATION, REFUND CONFIRMATION, REMINDERS TO ADD A CARD OR UPDATE A CARD AND OTHER NECESSARY EMAILS AND/OR TEXT MESSAGES IN ORDER TO PERFORM THE CARD ON FILE SERVICES.
YOU UNDERSTAND THAT TEXT AND EMAIL ARE UNSECURED MEANS OF COMMUNICATIONS, AND HAVE BEEN INFORMED THAT ANY OF YOUR REPLIES TO TEXT MESSAGES OR EMAIL MESSAGES FROM THE CARD PRODESSING SYSTEM THAT CONTAIN PATIENT HEALTH INFORMATION PROVIDED BY YOU CANNOT BE SECURED BY ME. YOU UNDERSTAND THAT TEXT MESSAGES YOU RECEIVE FROM THE CARD PROCESSING SYSTEM MAY NOT BE FREE, DEPENDING ON THE PLAN YOU HAVE IN PLACE WITH YOUR CELL PHONE COMPANY. YOU UNDERSTAND THAT YOU, NOT ME, ARE SOLELY RESPONSIBLE FOR ANY FEES ASSOCIATED WITH RECEIVING TEXT MESSAGES.
Optional, no Fee
Your use of the Card on File Service is entirely optional by you. If you wish to schedule an appointment you are not required to create a Card Profile or use the Card on File Service. There is no fee to have an active Card Profile.
You may cancel your active Card Profile any time by contacting me in writing. If you cancel, I will deactivate your active Card Profile and all eligible payment methods I have on record for you. Once deactivated, I cannot charge your active Card Profile. Upon any cancellation by you, all provisions of this Authorization, which by their nature should service will service, including without limitation, provisions, warranty, disclaimers, assumption of risk and indemnity, limitations and liability, and dispute resolution provisions.
Term and Termination
This Authorization will commence when you first create a Card Profile, and unless terminated earlier in accordance with this Authorization, will remain in force and effect for as long as you are using the Card on File Services.
I may terminate your Card Profile and your use of the Card on File Services, at my sole discretion, at any time and without notice to you. You may cancel your Card Profile at any time in accordance with this Authorization.
THE SERVICES AND CONTENT ARE PROVIDED “AS IS,” WITHOUT WARRANTY OF ANY KIND. WITHOUT LIMITING THE FOREGOING, I EXPLICITLY DISCLAIM ANY WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, QUIET ENJOYMENT OR NON-INFRINGEMENT, AND ANY WARRANTIES ARISING OUT OF COURSE OF DEALING OR USAGE OF TRADE. I make no warranty that the services will meet your requirements or be available on an uninterrupted, secure, or error-free basis. I make no warranty regarding the quality, accuracy, timeliness, truthfulness, completeness or reliability of any content.
Assumption of Risk and Indemnity
YOU KNOWINGLY AND FREELY ASSUME ALL RISK WHEN USING THE CARD ON FILE SERVICES. YOU, ON BEHALF OF YOURSELF, YOUR PERSONAL REPRESENTATIVES AND YOUR HEIRS, HEREBY VOLUNTARILY AGREE TO RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS, DEFEND AND INDEMNIFY DAVID LECHNYR, LCSW, DTSC, LLC, AND ITS OFFICERS, DIRECTORS, EMPLOYEES, CONSULTANTS, AGENTS, SUCCESSORS AND ASSIGNS, FROM AND AGAINST ANY CLAIMS, DISPUTES, DEMANDS, LIABILITIES, DAMAGES, LOSSES, AND COSTS AND EXPENSES, INCLUDING, WITHOUT LIMITATION, REASONABLE LEGAL AND ACCOUNTING FEES ARISING OUT OF OR IN ANY WAY CONNECTED WITH (I) YOUR ACCESS TO OR USE OF THE SERVICES OR CONTENT, INCLUDING THE RECEIPT OF COUNSELING OR COACHING SERVICES FROM ME OR (II) YOUR VIOLATION OF THESE TERMS, INCLUDING, WITHOUT LIMITATION, FOR BODILY INJURY, WRONGFUL DEATH, EMOTIONAL DISTRESS, LOSS OF SERVICES OR OTHER DAMAGES OR HARM, WHETHER TO YOU OR TO THIRD PARTIES, WHICH MAY RESULT FROM YOUR USE OF THE SERVICES. You will defend, indemnify and hold David Lechnyr, LCSW harmless from and against all claims, damages, liabilities, losses, expenses and costs (including reasonable fees and expenses of attorneys and other professionals) arising out of or resulting from: (a) your breach of these Authorization; (b) your use of the Card on File Services; (c) your alleged violation of any statute, ordinance, or regulation; or (d) any action by a third party against David Lechnyr, LCSW that is based on (i) your use of the Card on File Services or my services; or (ii) any act or omission that results in personal injury, death, or tangible or intangible property damage (including loss of use).
Limitation of Liability
NEITHER DAVID LECHNYR, LCSW NOR ANY OTHER PARTY INVOLVED IN CREATING, PRODUCING, OR DELIVERING THE CARD ON FILE SERVICES WILL BE LIABLE FOR ANY INCIDENTAL, SPECIAL, EXEMPLARY OR CONSEQUENTIAL DAMAGES, INCLUDING LOST PROFITS, LOSS OF DATA OR GOODWILL, SERVICE INTERRUPTION, COMPUTER DAMAGE OR SYSTEM FAILURE OR THE COST OF SUBSTITUTE CARD ON FILE SERVICES ARISING OUT OF OR IN CONNECTION WITH THIS AUTHORIZATION OR FROM THE USE OF OR INABILITY TO USE THE CARD ON FILE SERVICES, WHETHER BASED ON WARRANTY, CONTRACT, TORT (INCLUDING NEGLIGENCE), PRODUCT LIABILITY OR ANY OTHER LEGAL THEORY, AND WHETHER OR NOT I HAVE BEEN INFORMED OF THE POSSIBILITY OF SUCH DAMAGE, EVEN IF A LIMITED REMEDY SET FORTH HEREIN IS FOUND TO HAVE FAILED OF ITS ESSENTIAL PURPOSE. SOME JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, SO THE ABOVE LIMITATION MAY NOT APPLY TO YOU. I EXPRESSLY DISCLAIM LIABILITY FOR ANY MEDICAL, LEGAL AND ANY OTHER MALPRACTICE DAMAGE CLAIMS OR AWARDS, PAIN AND SUFFERING, PERSONAL INJURY/WRONGFUL DEATH, LOSS OF INCOME, LOSS OF CONSORTIUM, MEDICAL BILLS, LOSS OF PROGRAMS ARISING FROM OR RELATED TO USE OF THE CARD ON FILE SERVICES OR MY SERVICES.
IN NO EVENT WILL DAVID LECHNYR, LCSW’S TOTAL LIABILITY ARISING OUT OF OR IN CONNECTION WITH THIS AUTHORIZATION OR FROM THE USE OF OR INABILITY TO USE THE CARD ON FILE SERVICES OR MY SERVICES EXCEED $100. THE ASSUMPTION OF RISK AND LIMITATIONS OF DAMAGES SET FORTH ABOVE ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN DAVID LECHNYR, LCSW AND YOU.
Dispute Resolution; Agreement to Arbitrate
You and David Lechnyr, LCSW agree that any dispute, claim or controversy arising out of or relating to these terms or the breach, termination, enforcement, interpretation or validity thereof or the use of the Card on File Services (collectively, “disputes”) will be settled by binding arbitration, except that each party retains the right: (i) to bring an individual action in small claims court and (ii) to seek injunctive or other equitable relief in a court of competent jurisdiction to prevent the actual or threatened infringement, misappropriation or violation of a party’s copyrights, trademarks, trade secrets, patents or other intellectual property rights (the action described in the foregoing clause (ii), an “ip protection action”). The exclusive jurisdiction and venue of any ip protection action will be the state and federal courts located in Lane County, Oregon and each of the parties hereto waives any objection to jurisdiction and venue in such courts. You agree that you and David Lechnyr, LCSW are each waiving the right to a trial by jury or to participate as a plaintiff or class member in any purported class action or representative proceeding. Further, unless both you and David Lechnyr, LCSW otherwise agree in writing, the arbitrator may not consolidate more than one person’s claims, and may not otherwise preside over any form of any class or representative proceeding. If this specific paragraph is held unenforceable, then the entirety of this “dispute resolution” section will be deemed void. Except as provided in the preceding sentence, this “dispute resolution” section will survive any termination of these terms.
The arbitration will be administered by the American Arbitration Association (“AAA”) in accordance with the commercial arbitration rules and the supplementary procedures for consumer related disputes (the “AAA rules”) then in effect, except as modified by this “dispute resolution” section. (the aaa rules are available at https://www.adr.org/ or by calling the AAA at 1-800-778-7879.) The Federal Arbitration Act will govern the interpretation and enforcement of this section.
A party who desires to initiate arbitration must provide the other party with a written demand for arbitration as specified in the AAA rules. The arbitrator will be either a retired judge or an attorney licensed to practice law and will be selected by the parties from the aaa’s roster of arbitrators. If the parties are unable to agree upon an arbitrator within seven (7) days of delivery of the demand for arbitration, then the AAA will appoint the arbitrator in accordance with the AAA rules.
Arbitration Location and Procedure
Unless you and I otherwise agree, the arbitration will be conducted in Lane County, Oregon. If your claim does not exceed $10,000, then the arbitration will be conducted solely on the basis of the documents that you and I submit to the arbitrator, unless you request a hearing or the arbitrator determines that a hearing is necessary. If your claim exceeds $10,000, your right to a hearing will be determined by the AAA rules. Subject to the AAA rules, the arbitrator will have the discretion to direct a reasonable exchange of information by the parties, consistent with the expedited nature of the arbitration.
The arbitrator will render an award within the time frame specified in the AAA rules. The arbitrator’s decision will include the essential findings and conclusions upon which the arbitrator based the award. Judgment on the arbitration award may be entered in any court having jurisdiction thereof.
The arbitrator’s award of damages must be consistent with the terms of the “Limitation of Liability” section above as to the types and amounts of damages for which a party may be held liable. The arbitrator may award declaratory or injunctive relief only in favor of the claimant and only to the extent necessary to provide relief warranted by the claimant’s individual claim. If you prevail in arbitration you will be entitled to an award of attorneys’ fees and expenses, to the extent provided under applicable law. Your responsibility to pay any AAA filing, administrative and arbitrator fees will be solely as set forth in the AAA rules.
Notwithstanding the provisions of the “agreement changes” section above, if I change this “dispute resolution” section after the date you first accepted this Authorization (or accepted any subsequent changes to this Authorization), you may reject any such change by sending me written notice within 30 days of the date such change became effective, as indicated in the “last updated” date below or in the date of my email to you notifying you of such change. By rejecting any change, you are agreeing that you will arbitrate any dispute between you and myself in accordance with the provisions of this “dispute resolution” section as of the date you first accepted this Authorization (or accepted any subsequent changes to this Authorization).
This Authorization constitutes the entire and exclusive understanding and agreement between David Lechnyr, LCSW and you regarding the Card on File Services, and this Authorization supersedes and replaces any and all prior oral or written understandings or agreements between you and I regarding the Card on File Services. If for any reason a court of competent jurisdiction finds any provision of this Authorization invalid or unenforceable, that provision will be enforced to the maximum extent permissible and the other provisions of these Authorization will remain in full force and effect.
You may not assign or transfer this Authorization, by operation of law or otherwise, without my prior written consent. Any attempt by you to assign or transfer this Authorization, without such consent, will be null and of no effect. I may freely assign or transfer this Authorization without restriction. Subject to the foregoing, this Authorization will bind and insure to the benefit of the parties, their successors and permitted assigns.
Any notices or other communications provided by me under this Authorization, including those regarding modifications to this Authorization, will be given by me via email. The date of receipt will be deemed the date on which such notice is transmitted. My failure to enforce any right or provision of this Authorization will not be considered a waiver of those rights. The waiver of any such right or provision will be effective only if in writing and signed by me. Except as expressly set forth in this Authorization, the exercise by either party of any of its remedies under this Authorization will be without prejudice to its other remedies under this Authorization or otherwise.
If you have any questions about these Authorization or the Card on File Services, please contact me at:
David Lechnyr, LCSW
1598 Pearl Street, Suite 2
Eugene, Oregon 97401
Last Revised: February 9, 2020