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Please read and sign the following, applicable both to yourself as an individual attorney
and to your firm and all attorneys practicing therein:
I am requesting consultation from Physicians for Quality (PFQ), subject to the following:
- I understand that PFQ will provide me the name of a satisfactory expert in exchange for the fee paid
and that payment to the expert is my responsibility.
- I understand and agree that all statements made by PFQ in its advertising and this brochure are not
representations, express nor implied, but are merely expressions of intent and/or opinion.
- I understand that PFQ does NOT verify the information regarding credentials submitted by participating
experts and does NOT otherwise investigate suitability of any expert. In the event that an expert is found to
have falsified information, the liability of PFQ is limited to either obtaining another expert or
returning any fees paid by me or my firm to PFQ. PFQ is NOT
liable for any consequential damages. PFQ is NOT responsible for
experts who refuse to testify or who change their opinions, other than to
find a replacement or refund the fee paid. Refunds must be timely
requested.
- I understand that PFQ will contact the expert directly only for the purpose of making an
introduction. Then I will contact the expert and if he or she is unsuitable, I understand that PFQ will either help me to obtain
another expert or refund any fees paid by me to PFQ. I agree that
this guarantee does not apply if I drop the case, refer it to another
attorney, or otherwise do not need an expert due to circumstances not
within the control of PFQ.
- I agree NOT to contact independently any expert whose name is provided to me by PFQ for review,
consultation, testimony or any similar purpose for any case other than the
one named below for a period of ten years from the date of my signature on
this form, without first remitting an additional fee of $290 and order
form to PFQ; nor to aid another attorney or other party to contact
any such expert except in regard to this case. I understand that this
includes my voluntarily causing the name of such expert to be published in
any publication without prior authorization by PFQ.
- I understand that the services of PFQ are limited by availability. I understand that PFQ
will attempt to notify me in a timely fashion (usually within 7 days) if my request cannot
be accepted, or if it has been accepted, cannot be granted; but that it is
my responsibility to meet any deadlines. I agree that PFQ may
unilaterally cancel this order at any time during processing for any
reason, simply by returning my fee.
- I understand that PFQ's modest fee reflects my agreement that PFQ, under any circumstance, will
not be liable for any amount greater than the fee paid by me.
- I agree to be bound by the terms of this agreement for any future emergency orders I may place by
telephone, and to remit my check for $290 and a completed order form so
that they are received by PFQ within one week of my placing such
telephone order. I understand that failure to remit payment as agreed may
result in the notification of any experts supplied by PFQ of my
failure to honor financial commitments.
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Signature:
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Style of case:
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Name (printed):
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Specialty(ies) of physician desired:
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Name of firm:
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Number of specialties requested:
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Date of request:
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I am enclosing my check for $290 for each specialty requested.
Submit this completed form and your check for $290 for each specialty desired to
PFQ, 808 W. Bluebonnet Dr., San Marcos, TX 78666.
Our phone number is 800-284-3627 and our fax is 512-233-0642.
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