Electronic Records Disclosure and Consent Agreement

Please read this Electronic Records Disclosure and Consent Agreement (“Agreement”) carefully and download or print a copy for your records.  By accepting this Agreement, you acknowledge that you have received this Agreement and agree to its terms.

In this Agreement, the words “we,” “us,” “our” mean Superbill, Inc. (“SuperBill”) and its service providers including the provider of your healthcare services (“Provider”).
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Electronic Application and Related Disclosures

Federal laws and regulations and payment network rules require us to give you certain important disclosures and communications in writing relating to your use of the SuperPay service and other services we may offer (“Services”).  Without your consent, we are not permitted to give you these disclosures electronically. These disclosures include, but are not limited to, payment authorizations, and any other disclosures regarding your legal rights and obligations relating to your use of the Service, which are required by law to be provided in writing (the “Disclosures”). In addition, we may ask you to provide an electronic signature, affirmation, or other acceptance electronically. Your electronic acceptance or signature on any agreement or document has the same effect as if you signed it in ink.

Requesting Paper Copy of Disclosures

At your request, we will provide a copy of your Disclosures and agreement in paper-based media.  To request a paper copy of your Disclosures, please write to Superbill, Inc., 580 California St. Suite 1200, San Francisco, CA 94104.  We will not charge you any fees for providing a paper copy.

Your Consent is Required

You must consent to receiving the Disclosures electronically in order to access the Services. If you do not want to receive the Disclosures electronically, you should discontinue your use of our website and Services, and your access to the Services will be discontinued.

System Requirements to Access Electronic Disclosures and Communications

To receive an electronic copy of the Disclosures and other communications, you must have the following:

• a personal computer or other access device which is capable of accessing the Internet (e.g., you must have a modem, cable Internet connection or some other means of access to the Internet, and you must have an active account with an Internet service provider), and which can receive PDF and HTML files;
• a valid email address and, if you use a spam filter that blocks our re-routes emails from unknown senders, you must permit messages from the @thesuperbill.com domain in your spam filter. 
• a current version of a program that accurately reads and displays PDF files (e.g., Adobe Acrobat Reader);
• an Internet web browser which is capable of supporting Transport Layer Security (TLS) 1.2 or 1.3 encrypted communications; and
• TLS encryption software.

Your access to this page verifies that your system, browser and encryption software meet these requirements.
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System Requirements to Retain the Disclosures

To retain the Disclosures, your system must have the ability and sufficient storage space to either download (to your hard disk drive or other storage device) or print both web pages (screens) as well as embedded HTML and PDF files.

Updating Your Information

You must keep us informed of any change in your telephone number, email address, or mailing address.  You may contact us to tell us about these changes by e-mail at [email protected].  We will not assume liability for non-receipt of notification of availability of electronic Documents in the event your mobile number, email address or other contact information on file is invalid; your email or Internet service provider filters the notification as "spam" or "junk mail"; there is a malfunction in your computer, mobile device, browser, Internet service, mobile connectivity and/or software; or for other reasons beyond our control.

Withdrawing Consent

You are free to withdraw your consent to this agreement at any time.  To do so, please submit a request to withdraw your consent by email at [email protected].  Any withdrawal of your consent will be effective after a reasonable period of time for processing your request.  The legal effectiveness, validity and enforceability of Disclosures that were previously provided or signed electronically will not be affected.  If you withdraw your consent, we declare all amounts you owe us immediately due and payable, and we may close or limit access to our services. You agree to pay any amount you owe us even if you withdraw your consent or we close or limit access to your account.

Acceptance of Agreement and Consent to Receive Electronic Disclosures

Before you may access our services, you must accept this Agreement.  If you do not accept this Agreement, your use of the Services will be discontinued.

By accepting this Agreement, you hereby confirm that:

• you agree to be bound by the terms of this Agreement;
• the Internet access device(s) you will use to complete your on-line application and to receive the Disclosures meet(s) the system requirements described above;
• you consent to receiving the Disclosures electronically; 
• you authorize us to send the Disclosures electronically or by mail to any email address, mobile telephone number, mailing address, or other contact information you have provided or made available to us;
• the Disclosures that we provide electronically have the same meaning and effect as if provided in paper form; and
• your electronic acceptance or signature on any agreement or document has the same effect as if you signed it in ink.