Arbitration Agreement

PHYSICIAN-PATIENT BINDING ARBITRATION

I. Agreement to Binding Arbitration. Any claim or dispute (including the interpretation and scope of this Arbitration Clause, and the arbitrability of the claim or dispute) between you and us or our employees, agents, successors or assigns, which relates to the rendering of any medical, emergency, elective or cosmetic services, including but not limited to, whether any of services rendered were unnecessary or unauthorized or were improperly, negligently, or incompetently rendered, will be determined by submission to binding arbitration and not by a lawsuit or resort to court process. Both parties to this contract agree to give up their respective rights to a jury trial, to have any such dispute decided in a court of law and their right to appeal, and instead accept the use of binding arbitration. Any claim or dispute is to be arbitrated on an individual basis and not as a class action. This Arbitration Agreement shall be governed by the Federal Arbitration Act (9 U.S.C. § 1 et. seq.) and not by any state law concerning arbitration except as expressly stated herein.

II. Initiating Arbitration. Arbitration shall be initiated by serving a written Demand for Arbitration. The Demand for Arbitration shall include the basis of the claim; the amount of damages the Claimant seeks in the arbitration; the names, addresses, and telephone number of the Claimant and their attorney, if any; and the names of all Respondents. Claimant shall include all claims against Respondents that are based on the same incident, transaction or related circumstances in the Demand for Arbitration.

III. Serving the Demand for Arbitration. A Demand for Arbitration shall be served by mailing it to the Medical Group addressed as follows:REBECCA SMALL, M.D.828 BAY AVENUECAPITOLA, CA 95010Service on the Respondent shall be deemed completed when received. All other Respondents, including individuals, must be served as required for a civil action.I

V. Selection of Arbitrator(s). If the demand for Arbitration seeks total damages of $100,000 or less, the dispute shall be heard and determined by one neutral arbitrator, unless the parties otherwise agree in writing. The neutral arbitrator shall not have authority to award monetary damages that are greater than $100,000. If the Demand for Arbitration seeks total damages of more than $100,000, the dispute shall be heard and determined by one neutral arbitrator and two party arbitrators (one jointly appointed by all Claimants and one jointly appointed by all Respondents). Parties who are entitled to select a party arbitrator may agree to waive this right. If all parties agree, these arbitrations will be heard by a single neutral arbitrator. The neutral arbitrator selected by the parties or the party arbitrators shall be a retired judge from the California Superior Court or a United States District Court in California. In the event that the parties or the party arbitrators cannot agree on the selection of the neutral arbitrator, the dispute shall be submitted to Judicial Arbitration & Mediation Services (JAMS) for a list of three retired judges from the California Superior Court or a United States District Court in California. Each party or party arbitrator can strike one name from the list and the remaining name shall be appointed as the neutral arbitrator. The neutral arbitrator shall be selected within 60 days of receipt of the Demand for Arbitration.

V. Payment of Arbitrators Fees and Expenses. Unless otherwise provided by applicable law as determined by the arbitrator, each party shall pay for their pro rata share of the fees and costs of the neutral arbitrator together with the fees and costs or its party arbitrator, if applicable. This does not include counsel fees, expert fees or witness fees, or any other expenses incurred by a party for such party’s own benefit; all such fees and costs incurred by such party shall be paid by such party.

VI. Conduct of Arbitration. The Arbitration Hearing shall be conducted in the County where venue would be proper if the matter was brought as a civil action. Arbitrations shall be conducted according to the California Code of Civil Procedure commencing with section 1282. The California Medical Injury Compensation Reform Act of 1975 (“MICRA”) (including any amendments thereto) including sections establishing the right to introduce evidence of any insurance or disability benefit payment to the patient, the limitation on recovery for noneconomic losses, and the right to have an award for future damages conformed to periodic payments, shall apply to any claims for professional negligence or any other claims as permitted or required by law. Either party shall have the absolute right, exercisable at any time, to have binding arbitration separately and with different arbitration panels for the issues of liability and damages upon written request to the neutral arbitrator. If liability and damages are bifurcated, and there is a finding of liability, the parties will select another neutral arbitrator to hear the issue of damages using the same selection process as set forth in Article 4, above. With respect to any matter not herein expressly provided for, the California Code of Civil Procedure provisions relating to arbitration shall govern arbitrators.

VII. Claims to be Submitted to Binding Arbitration. All claims for monetary damages exceeding the jurisdictional limit of the small claims court must be submitted to binding arbitration, including, without limitation, claims for loss of consortium, wrongful death, loss of earnings, future medical bills and other related support, emotional distress, punitive damages or unpaid fees. The filing of any action in any small claims court by the physician to collect any fee from the patient shall not waive the right to compel binding arbitration of any other claim provided herein. It is the intention of the parties that this agreement bind all parties whose claims may arise out of or relate to treatment or service provided by the physician, including, any spouse or heirs of the patient and any children whether born or unborn, at the time of the occurrence giving rise to any claim, including, without limitation, wrongful death on behalf of patient or any heir, successor or assign. In the case of any pregnant mother, the term "patient" herein shall mean both the mother and the mother's expected child or children. The parties consent to the intervention and joinder in this binding arbitration of any person or entity that would otherwise be a proper additional party in a court action, and upon such intervention and joinder any existing court action against such additional person or entity shall be stayed pending the binding Arbitration.

VIII. General Provisions. All claims based upon the same incident, transaction or related circumstances shall be the subject of binding arbitration in one proceeding. A claim shall be waived and forever barred if (1) on the date notice thereof is received, the claim, if asserted in a civil action, would be barred by the applicable California statute of limitations, (2) the claimant fails to pursue the binding arbitration claim in accordance with any procedures prescribed herein with reasonable diligence; or (3) the arbitration hearing is not commenced within five years after the earlier of (a) the date the Demand for Arbitration was served in accord with the procedure described herein, or (b) the date of filing of a civil action based upon the same incident, transaction, or related circumstances involved in the claim. A claim may be dismissed on other grounds by the neutral arbitrator based on a showing of good cause. If a party fails to attend the arbitration hearing after being given due notice thereof, the neutral arbitrator may proceed to determine the controversy in the party’s absence.

IX. Revocation. This agreement for binding arbitration may be revoked by written notice delivered to the physician within 30 days of signature. If it is revoked, then binding arbitration will not apply. If it is not revoked within 30 days, then binding arbitration shall apply.

X. Retroactive Effect. If the parties intend this Agreement to cover medical services described in Article I rendered prior to the date of acknowledgment, the patient acknowledges and agrees that this Agreement applies retroactively to the date the medical or emergency services were provided.