Weight Loss Referral Form

Eligibility:

– The Program is available to self-pay patients only.

– Credits cannot be applied toward insurance copays, coinsurance, or deductibles.

– You must be an active participant in the CommunityMed Weight Loss Program to earn referral credits.

Referral Credits:

– A $25 credit will be issued for each eligible new patient referral.

– To qualify, the referred patient must use your unique referral code and successfully enroll in the Weight Loss Program.

– Referral credits are applied at the end of each month and redeemable the following month.

– If a referral joins shortly before your next scheduled refill, the credit may not be available until the following month.

– Credits are non-transferable, have no cash value, and expire three (3) months from the date applied.

Referral Limits:

– You may earn up to 10 referral credits per month (maximum of $250 in credits).

– Additional referrals will not generate credits beyond this monthly limit.

New Patient Offer:

– Referred patients will receive $25 off their first month when they join the Weight Loss Program using a referral code.

Milestone Rewards:

– Patients who achieve five (5) eligible referrals will receive one (1) Wellness Kit and one (1) $50 Visa Gift Card.

– Milestone rewards are issued after verification of referral activity.

Program Changes & Termination:

– CommunityMed reserves the right to modify, suspend, or terminate the Program at any time without prior notice.

– Fraudulent activity or misuse of referral codes will result in disqualification from the Program and forfeiture of any earned credits or rewards.

General:

– Participation in the Program constitutes acceptance of these Terms & Conditions.

– CommunityMed’s decisions regarding Program eligibility, credits, and rewards are final.