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On-Demand Membership Registration

ON-DEMAND MEMBERSHIP PROGRAM

WHAT THIS PROGRAM IS
Dr. Prem Ramkumar offers an On-Demand Membership Program that provides patients with direct, prioritized access to him between office visits. This allows you to receive surgeon-level guidance about symptoms, imaging, recovery, and treatment decisions without unnecessary delays.

This service is not billed to your insurance. It is a premium concierge communication service that supplements, but does not replace, standard medical care.

WHO THIS SERVICE IS FOR
This program is designed for patients navigating:

• Surgical planning
• Post-operative recovery
• Complex imaging or diagnoses
• Ongoing orthopedic concerns

WHAT IS STILL PROVIDED THROUGH THE OFFICE
All patients, whether enrolled or not, continue to have access to:

• Phone support from Dr. Ramkumar’s staff during business hours
• After-hours answering service
• In-office appointments
• Urgent care centers and emergency rooms

WHAT THE MEMBERSHIP INCLUDES

• Email, phone, or text access to Dr. Ramkumar
• Same-week in-office appointments when available

MEDICAL & EMERGENCY DISCLAIMER
Concierge communication provides general medical guidance, clarification, and care coordination. It does not replace physical examinations, diagnostic testing, or emergency care. Urgent or life-threatening symptoms must be directed to 911, an emergency department, or urgent care.

PAYMENT & REFUND POLICY
Membership fees pay for access and availability - not for a specific diagnosis, outcome, or guaranteed response time. Once concierge access is activated by your first message to Dr. Ramkumar, the service is non-refundable, even if you do not use it. Membership time begins once your receipt and waiver are received and you initiate contact with Dr. Ramkumar. Unused time does not roll over.

HIPAA & PRIVACY
Concierge communications are handled using HIPAA-compliant systems whenever possible and may become part of your medical record. By enrolling, you consent to the use of secure electronic communication for non-urgent medical guidance and care coordination. No electronic system is completely risk-free. Your health information is never sold or shared outside your care team except as permitted by HIPAA.

CREDIT CARD DESCRIPTOR
Your statement will show a charge from PREM RAMKUMAR MD, INC.

ACKNOWLEDGMENT
By completing payment and signing this form, I confirm that I have read and understood the terms outlined above.

I confirm that I have read and understood the terms outlined above.

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Timestamp

Audit

January 12, 2026 6:36 pm PST

On-Demand Membership Registration Uploaded by Prem Ramkumar MD - ramkumar@commonsclinic.com IP 47.187.160.20

January 12, 2026 7:07 pm PST

Ramkumar Practice - drramkumar@emedicalmedia.net added by Prem Ramkumar MD - ramkumar@commonsclinic.com as a CC'd Recipient Ip: 47.187.160.20

January 13, 2026 1:13 pm PST

Ramkumar Practice - drramkumar@emedicalmedia.net added by Prem Ramkumar MD - ramkumar@commonsclinic.com as a CC'd Recipient Ip: 47.187.160.20