By signing our policy guide lines, you are waiving your right to a jury trial and you are agreeing to arbitrate all claims arising out of or related to your medical care and treatment.

Arbitration agreement for claims arising out of or related to medical care and treatment

Agreement to arbitrate claims regarding future care & treatment

The patient agrees that any controversy, including without limitation, claims for medical malpractice, personal injury, loss of consortium, or wrongful death, arising out of or in any way relating to the diagnosis, treatment, or care of the patient by the undersigned provider of medical services, including any partners, agents, or employees of the provider of medical services, shall be submitted to binding arbitration.

Agreement to arbitrate claims regarding past care & treatment

The patient further agrees that any controversy, including without limitation, claims for medical malpractice, personal injury, loss of consortium, or wrongful death, arising out of or in any way relating to the past diagnosis, treatment, or care of the patient by the undersigned provider of medical services or the provider’s partners, agents or employees, shall be submitted to binding arbitration.

Waiver of right to jury trial

Both parties to this agreement, by entering into it, are giving up their constitutional right to have any such dispute decided in a court of law before a jury, and instead are accepting the use of binding arbitration.

All claims must be arbitrated by all claimants

All claims based upon the same occurrence, incident, or care shall be arbitrated in one proceeding. It is the intention of the parties that this Agreement bind all parties whose claims may arise out of or relate to treatment or services provided by the provider of medical services, including the patient, the patient’s estate, any spouse or heirs of the patient, and any children of the patient, whether born or unborn, at the time of the occurrence giving rise to the claim. In the case of any pregnant mother, the term “patient” herein shall mean both the mother and the mother’s expected child or children. By signing this Agreement, the parties’ consent to the participation in this arbitration of any person or entity that would otherwise be a proper additional party in a court action.

Arbitration procedures

The parties agree and recognize that the substantive provisions of Florida Statutes, Chapter 766, governing medical malpractice claims shall apply to the parties and/or claimant(s) in all respects, except that at the conclusion of the pre-suit screening period and provided there is no mutual agreement to arbitrate under Florida Statutes, 766.106 or 766.207, et seq. (which remain available if elected by the parties), the parties and/or claimant(s) shall resolve any claim through arbitration pursuant to this Agreement. Within thirty (30) days after a party to this Agreement has given written notice to the other of a demand for arbitration of said dispute or controversy under this Agreement, the parties to the dispute or controversy shall each appoint an independent arbitrator who is a member of the American Health Lawyers Association and give notice of such appointment to the other. Within a reasonable time after such notices have been given the two arbitrators so selected shall select a neutral arbitrator, who shall be an administrative law judge furnished by the Florida Division of Administrative Hearings and give notice of the selection thereof to the parties. The arbitrators shall hold a hearing within a reasonable time from the date of notice of selection of the neutral arbitrator. The parties agree that the arbitration proceedings are private, not public, and the privacy of the parties and of the arbitration proceedings shall be preserved.

Arbitration expenses

Each party shall bear the cost of her/its own attorneys’ fees, the costs of presenting her/its case, and her/its arbitrator. Any cost associated with the neutral arbitrator shall be shared equally by the parties, to the extent not provided by the State Department of Administrative Hearings. Other costs of the arbitration (e.g. of securing a location for the arbitration, court reporter, etc.) shall be share by the parties.

Applicable Law

Except as herein provided, the arbitration shall be conducted and governed by the provisions of the Florida Arbitration Code, Florida Statutes, Section 682.01 et seq. In conducting the arbitration under Florida Statutes, Section 682.01 et seq., all substantive provisions of Florida law governing medical malpractice claims and damages related thereto, including but not limited to, Florida’s Wrongful Death Act, the standard of care for medical providers, the applicable statute of limitations and the application of collateral sources and setoffs shall be applied. Except as otherwise provided by law, interest shall only accrue after an award by the arbitration panel. Post-decision interest shall be computed in a manner consistent with other civil claims. The provisions of Fla. Stat. § 768.81 regarding comparative fault shall apply.

Effect of refusal to proceed with arbitration

In the event that any party to this Agreement refuses to go forward with arbitration, the party compelling arbitration reserves the right to proceed with arbitration, the appointment of an arbitrator, and hearings to resolve the dispute, despite the refusal to participate or absence of the opposing party. Submission of any dispute under this agreement to arbitration may only be avoided by a valid court order, indicating that the dispute is beyond the scope of this Agreement or contains an illegal aspect precluding the resolution of the dispute by arbitration. Any party to this Agreement who refuses to go forward with arbitration hereby acknowledges that the arbitrator will go forward with the arbitration hearing and render a binding decision without the participation of the party opposing arbitration or despite that party’s absence at the arbitration hearing.


If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision.

Acknowledgements by patient

The patient, by signing this Agreement, also acknowledges that he or she has been informed that:

  • NO DURESS. The Agreement may not be submitted to a patient for approval when the patient’s condition prevents the patient from making a rational decision whether or not to agree;
  • AGREEMENT BASED UPON OWN FREE WILL. The decision whether or not to sign this Agreement is solely a matter for the patient’s determination without any influence by the medical provider;

Binding arbitration and effect on right of appeal

Binding arbitration means that the parties give up their right to go to court to assert or defend a claim covered by this Agreement. The resolution of claims covered by this Agreement will be determined by a neutral panel of arbitrators and not a judge or jury. Each party is entitled to a fair hearing, but the arbitration procedures are simpler and more limited than rules applicable in court. Arbitration decisions are as enforceable as any court order. The decision of an arbitration panel is final and there will generally be no right to appeal an adverse decision. However, any party may, within 15 days from a decision of an arbitration panel, file a written request for reconsideration. Any such request for reconsideration shall be based upon (i) a claim that the panel failed to properly apply the law or applicable rules of evidence or (ii) that the procedures specified in this Agreement or Fla. Stat. §§ 682.01, et seq. were not followed. A claim that the panel was incorrect as to the facts, or gave undue weight to certain evidence will not be a basis for a request for reconsideration; and

Signature of agreement

This Agreement shall be effective upon the patient’s and/or the patient’s representative’s signature below. Upon such signature, this Agreement shall be deemed to be fully executed and binding upon all parties.