Sample Medical Tourism Agreement Clauses

Facilitator and Patient Agreement

This contract does the heavy lifting of separating you from medical liability while locking in your payment protection. It states plainly:

“Facilitator acts only to coordinate the Medical Procedure, travel, and accommodations the Patient seeks. Facilitator is not acting as a medical advisor, physician, or providing medical advice of any kind.”

It also builds in a real financial safety net most facilitators never think to require. Before treatment begins, the patient must provide a Letter of Credit or an internationally accepted credit card with a pre-authorization limit equal to or greater than 50% of the estimated procedure cost, and it must meet strict requirements:

“The Security Instrument must be non-revocable and payable to Facilitator… Facilitator must be able to draft against the Security Instrument upon request… The Security Instrument must not expire within twelve (12) months of issuance.”

There’s also a firm rescheduling clause protecting your time and resources:

“Rescheduling of any or all of the Package is very difficult and will incur additional costs. If Patient requests to reschedule the Package, Patient must submit to Facilitator such request in writing at least twenty-five (25) calendar days prior to the original travel start date… Failure to submit the rescheduling request within such time will result in forfeiture of Patient’s deposit.”

And on complications, the language is direct:

“Patient understands complications can arise from the Medical Procedure Patient has chosen, which can result in injury and/or death… Patient hereby waives and releases Facilitator from all liability arising from or damages caused by the chosen Medical Procedure.”

Patient Waiver and Liability Release

This is the document your patient signs before anything else happens, 11 separate acknowledgments that protect you from the moment you take them on as a client. Among them:

“Facilitator’s Services do not include medical advice, guidance, treatment, therapy, prescribing of medications, or any other health, medical or therapeutic services of any kind.”

“Participant understands and accepts that all Medical Procedures may involve serious risks including injury and/or death and such risks are inherent and cannot be eliminated or completely avoided through exercise of any degree of diligence or care.”

It even accounts for unexpected costs mid-treatment, granting you direct authority to bill for them:

“Participant grants Facilitator the authority to cover such additional charges using the credit card Participant has provided to and is on file with Facilitator.”

And it closes with the patient formally waiving claims and agreeing to indemnify you:

“I hereby waive any and all claims I may have against Facilitator… Indemnify, defend, release, and hold the Released Parties harmless from all Claims (including attorney’s fees) arising from or related to Facilitator’s Services or Medical Services.”

Facilitator-Hospital Agreement

This is a full consulting agreement, built on a 36-month term with three supporting exhibits (Advertising, Confidentiality, and General Conditions), and it locks in real financial terms most facilitators never negotiate on their own.

Your commission is defined in writing:

“Facilitator shall receive 15% of the patient’s final total cost for all services provided by Hospital… If upon reconciliation of final costs after completion of all services any patient account reflects Facilitator has received total commission payment in excess of 15%, Facilitator shall refund such excess to Hospital.”

Hospitals are held to real response standards:

“Hospital will respond to all correspondence from patients provided by Facilitator within two (2) business days from receipt of such inquiry.”

And you’re protected if a hospital ever falls out of compliance:

“Hospital shall provide to Facilitator sufficient proof of necessary licensure of its physicians and accreditation of its facility… Failure to provide such proof, or loss of licensure or accreditation shall void Facilitator’s obligations pursuant to this agreement and release Facilitator for any liability related to this Agreement or any services performed.”

Pricing changes require real notice, not a surprise invoice:

“Pricing may only be changed upon thirty (30) days’ written notice to Facilitator. Pricing shall not be changed for patient procedures once scheduled by Facilitator.”

Patient Pre-Screening and Medical History Form

A complete intake document built to surface risk before you ever book a trip, covering current medications, past surgeries, chronic conditions, allergies, prior hospitalizations, alcohol and tobacco use, and family medical history. As the document itself states:

“This information will give you a health profile of the patient including all information that might in anyway complicate the trip, so that in case of any unfortunate circumstances the blame does not fall on your business.”

Medical Traveler Application

A structured, itemized attachment covering flights, lodging, procedure, aftercare, insurance, and fees, signed and initialed by both parties, so there’s a documented record of exactly what was promised and at what price:

“Patient agrees the options in Attachment 1 are the only options Patient has agreed to receive, the pricing for the options are accurate, and the conditions of the pricing and options are accepted.”