Ophthalmology Resources

Practice Name:	*
Contact Name:	*
Doctor Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone #:	*
Fax #:	*
Cell #:
Email:	*
Number of Dispensing Locations:	*
Ophthalmology Resources, llc Optical Production Tracking Software Agreement and Terms & Conditions This Ophthalmology Resources, llc ("Agreement") is a contract between you and Ophthalmology Resources, llc and applies to your use of the "Optical Production Tracking Software" product. This Agreement applies to a user Agreement of the "Optical Production Tracking Service". If you do not agree to be bound by this Agreement, then you should not use or access the Optical Production Tracking Service owned by Ophthalmology Resources, llc. User Sign-up Fee Agreement Ophthalmology Resources, llc will charge an initial User Sign-up Fee for each customer/owner/practice that will be utilizing the Optical Production Tracking Service. The initial sign-up fee will be for one location and there will be an additional fee for each additional location that the same customer/owner/practice operates. When the initial fee is paid, you will be enrolled in the program (within 10 days) and receive a Login name and Password which will enable you to participate in the program. The customer must fill out the User Sign Up Information form entirely in order to qualify for the enrollment. Having signed up and submitted the User Sign-up Information form should you decide to suspend your participation in this program for any reason, the initial sign-up fee is non- refundable. If you have suspended using the service and desire to re-enroll, payment arrangements must be re-negotiated directly with Ophthalmology Resources, llc. Your User Sign-up Agreement is non-transferable All rights and privileges of this program belong to Ophthalmology Resources, llc Monthly Fee Agreement In addition to the initial sign-up fee as set out in the User Sign-up Fee Agreement, you agree to pay a Monthly Fee for 1 dispensing location (see additional location fees as outlined in the User Sign-up Information) for use of the Optical Production Tracking Service and an additional Monthly Fee for each dispensing location that you own. You agree to allow Ophthalmology Resources, llc, to withdraw the Monthly Fee from your account or other funding sources. The Monthly Fee will be paid by you every month in advance, beginning in the next full month following acceptance of this agreement, and will be non-refundable. You may not receive an advance notice before Ophthalmology Resources, llc withdraws the Monthly Fee from your account. In the event that Ophthalmology Resources is unable to withdraw this amount from your account, Ophthalmology Resources may terminate your use of the Optical Production Tracking Service within 10 days of the first of the month, the date that the Monthly Fee was due. You will remain obligated to pay Ophthalmology Resources, llc for any unpaid Monthly Fees. This Monthly Fee is subject to change at Ophthalmology Resources, llc sole discretion upon completion and expiration of your initial contract period. The Monthly Fee will be paid as follows: Ophthalmology Resources will pull the Monthly Fee from either your bank account, credit card, or debit card. The designated funding source will be set-up with the initial User Sign Up Information documentation. If you desire to change the payment source you must contact Ophthalmology Resources, llc in writing, 30 days prior to the first of the next month in order for it to take effect. Usage of the Optical Production Tracking Service As part of the application process for usage of the Optical Production Tracking Service, you must provide Ophthalmology Resources, llc, with the responsible party's name, business/practice name, address, telephone number and email address. In addition we require any one of the following: bank name and bank account, credit card or debit card number. Credit/debit cards must furnish your expiration date and the three digit security code. You also agree to allow Ophthalmology Resources, llc, to store all such information and use it to evaluate your continuing eligibility for usage of the Optician Production Tracking Service, as well as to share it with the third parties involved in the payment transaction. Ophthalmology Resources, llc will accept or deny your application for usage of the Optical Production Tracking Service usually within one business day of submission. Ophthalmology Resources, llc may deny your application due to your credit history, Ophthalmology Resources, llc history, or for any other reason in Ophthalmology Resources, llc discretion. Program Ownership Ophthalmology Resources, llc is the sole and exclusive owner of "Optical Production Tracking Software". Ophthalmology Resources, llc assigns through this contract exclusively, the right for the customer to utilize this specific service. This right is only in effect if the customer has paid for the service and the account is in good standing. Any effort to assign this service to a different party other than the party who signed and contracted the original agreement with Ophthalmology Resources, llc, is prohibited. Data Entry Upon acceptance of this User Agreement, Ophthalmology Resources, llc will issue you a Login and Password so that you can begin Data Entry. Your Login and Password are uniquely yours and are not transferable. Should you suspend your agreement with Ophthalmology Resources, llc, both your Login and Password will become inaccessible and be terminated. By entering into this agreement, Ophthalmology Resources, llc and you agree that you will provide data entry into the specified "Patients" data entry sheets. Ophthalmology Resources, llc cannot monitor the accuracy of your data entry and therefore cannot be held responsible or liable if the data entry is inaccurate. If data is lacking or insufficient, Ophthalmology Resources will not be able to provide the Monthly Production Reports until that month's data has been accurately entered and completed. Certain data about the customer/practice must be provided in addition to the on-line "Patient" data entry sheets. This includes, but is not limited to: 1. Number of patients seen by each doctor and number of Rx's written by doctor. 2. Number of man hours worked by each optician per week. 3. Names and types of insurances accepted by the practice's optical. 4. Initials of the Practice Doctors. 5. Initials of all optical dispensers. Report Production Assuming that the customer data entry is accurate, Ophthalmology Resources, llc will provide Monthly Production Reports. Each report and the line items within each report will be tracked, provided that you have provided all the data necessary to calculate that line item. Each month while under this agreement, Ophthalmology Resources, llc will provide four (4) analysis reports to you as follows: Optician Financial Analysis, Optician Product Analysis, Insurance Analysis and Doctor and Optical Production Report. By signing this agreement, you signify that they have seen these sample reports and agree that is what they have contracted for. If you require other reports over and above these reports, the preparation of these reports will be negotiated under a separate contract agreement with Ophthalmology Resources, llc. Data Privacy Ophthalmology Resources, llc agrees to hold strictly confidential the following information: customer names, company/practice names, street addresses, doctors names, optician/optical dispensary names, all specific financial line item information as linked to a specific customer/practice, all specific product information as linked to a specific customer/practice, all specific insurance information as linked to a specific customer/practice and any specific patient information as linked to a specific customer/practice. Data Usage Ophthalmology Resources, llc does however reserve the right to utilize the data and information it will generate from the above mentioned reports as a whole for the purposes of analyzing trends in both products and financial data that will emerge over a period of time. Data Ownership While under this Agreement, the data detail (as specified in "Data Privacy") gathered by Ophthalmology Resources, llc, will be owned by you, the Customer. However, you agree that this data, in collection with all the other participating customers' data collected by Ophthalmology Resources, llc, through this program, and which is used to produce the specified Production Reports, as detailed in "Report Production"; that Ophthalmology Resources will have the ownership of the cumulative date for use as indicated in "Data Usage". Disclaimer OPHTHALMOLOGY RESOURCES, LLC, "OPTICAL PRODUCTION TRACKING SOFTWARE" AND ALL ACCOMPANYING DOCUMENTATION ("SERVICES") ARE PROVIDED TO YOU ON AN "AS IS" BASIS WITHOUT ANY WARRANTIES, EITHER EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY WARRANTIES OF TITLE, NON-INFRINGEMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. OPHTHALMOLOGY RESOURCES, LLC MAKES NO WARRANTY THAT THE SERVICES WILL BE ERROR-FREE.
	I agree to the these terms