Our Practice Agreement

PRESENCEMD LLC
Torree McGowan, MD
Oregon & Alaska Licensed Physician


PATIENT AGREEMENT — 2026
Welcome to PresenceMD. This agreement covers your care with us — please read it, ask any questions you have, and sign when you're ready. It's written to be straightforward, not intimidating.


WHO WE ARE
PresenceMD LLC is a mobile, cash-pay physician practice led by Dr. Torree McGowan, MD, bringing physician-level care directly to the local and equestrian community — at shows, events, and via telehealth between circuits.

This agreement is between PresenceMD LLC ("the Practice," "we," or "us") and you, the patient ("you" or "your").

WHAT WE OFFER
We provide care in two ways, and this agreement covers both:

Subscription Membership: Ongoing specialty care — Obesity Medicine/GLP-1 and Hormone Therapy (MHT) — with a recurring monthly, quarterly, or annual fee covering care management visits, telehealth follow-ups, and messaging access.Show Day / Fee-for-Service Care: Urgent care, wound care, diagnostics, and procedures seen at events and billed at the time of service. No membership required.


Your specific services and fees are set out in writing when you enroll or at the time of your visit.

PAYMENT
Subscription Membership
Your membership fee is billed automatically on the 1st of each billing period (monthly, quarterly, or annual) via the Atlas MD secure EHR platform. Payment is by credit card, debit card, or ACH debit kept securely on file. You'll receive a receipt automatically after each charge. No surprise bills — your membership fee is exactly what it says.

If we need to change your membership fee or the services it covers, we'll give you 30 days’ written notice, and you can cancel before the change takes effect.

Show Day / Fee-for-Service
Show day services are billed and collected at the time of service, also through the Atlas MD platform or by credit/debit card. Pricing is published on the PresenceMD show day price sheet, posted at the clinic at every event and available at presencemd.com.

What's Not Included in Your Fee
A few things are always billed separately, no matter which model you're on:
Prescription medications (dispensed separately or routed to a pharmacy of your choice)
Laboratory fees (billed directly by the lab — typically Quest or LabCorp)
Any additional procedure or treatment identified during your visit — we will always discuss and get your consent before any additional charge

Cancellation & Refunds
You can cancel your membership any time. Monthly memberships: 14 days’ written notice before your next billing date. Quarterly and annual memberships: 30 days’ notice, with a pro-rata refund of any unused paid time. First-time annual members get a 90-day satisfaction guarantee — if it’s not working for you in the first 90 days, we’ll make it right.

INSURANCE & MEDICARE
PresenceMD LLC is a 100% cash-pay practice. We don’t bill Medicare, Medicaid, or any private insurance — and we don’t participate in any health plans or HMO panels. This keeps things simple, transparent, and fast.

This agreement is not health insurance. It covers only the services we personally provide, as described above. We strongly encourage you to maintain health coverage for hospital care, specialist visits, and anything else outside our scope.

Medicare Note: If you are a Medicare beneficiary, PresenceMD LLC does not file Medicare claims for the services in this agreement. You will not be reimbursed by Medicare for these services, and you agree not to submit a claim to Medicare for care provided by PresenceMD LLC. If you are or become eligible for Medicare, please let us know right away — a brief supplemental agreement is required.


Hospital & Emergency Department Encounters
Occasionally, you may encounter Dr. McGowan in her capacity as a hospital emergency physician — separate from PresenceMD LLC. If you receive care from Dr. McGowan in an emergency department setting, that encounter is billed under the hospital's billing policy and your health insurance (if any), not under this agreement. Your PresenceMD membership does not cover physician fees for emergency department visits — those are a completely separate professional relationship governed by the hospital's standard billing practices.

HOW WE COMMUNICATE
We want to be easy to reach. Our preferred communication channel is the Atlas MD patient app, which is free to download and free for you to use. Through the app you can message Dr. McGowan directly, request prescription refills, schedule telehealth visits, and access your visit records — all in a HIPAA-secure environment.

We also communicate by phone, email, and text when needed. A quick note on electronic communication generally: while we always do our best to protect your privacy, no email or text message can be 100% guaranteed secure. By signing this agreement, you acknowledge that and agree that reaching out to us by those channels is your choice — it's never required, and you can opt out of any particular method at any time.

For emergencies: Please do not use the app, text, or email in a medical emergency. Call 911 or go to the nearest emergency room. Electronic messaging is not monitored in real time and is not appropriate for time-sensitive or life-threatening situations.


AI Documentation: We use an AI-powered transcription tool to help document your visits accurately. It listens during your appointment and generates a draft note that Dr. McGowan reviews, edits, and approves. You can opt out at any time — just let us know before your visit starts. Opting out won't change your care at all.

DR. MCGOWAN'S AVAILABILITY
Dr. McGowan is passionate about being accessible to her PresenceMD patients — but she also practices emergency medicine on rotating hospital shifts. This means there will be times she is unavailable because she is on shift at the hospital, sleeping between nights, or traveling to an event.

Here's what you can count on: if you send a message and can't reach her, she will respond within 24 hours. If your concern feels urgent and cannot wait 24 hours, please do not wait for a response — go to an urgent care or emergency room and get the care you need right away.

Response commitment: Dr. McGowan will respond to all patient messages within 24 hours unless she has informed patients of a prolonged period of not being available. If you have a concern that can't safely wait — please call 911 or go to the nearest emergency department. Your safety comes first, always.


When Dr. McGowan is away from shows due to schedule conflicts, illness, or other commitments, she will give Members as much advance notice as possible. Telehealth access remains available to Subscription Members regardless of show attendance.

OUR SCOPE — AND WHEN WE'LL REFER YOU
PresenceMD LLC is equipped to handle a wide range of urgent care, wound care, and specialty care concerns. But we operate as a mobile practice, and some situations are simply better handled in a hospital or specialist setting.

If we determine that your injury or illness is more serious than we can safely manage in our mobile setting, we will stabilize you on-site and refer you to the nearest emergency department for further evaluation. We will always be transparent with you about what we can and can't do — and we will never leave you without a clear next step.

A FEW LEGAL POINTS
We try to keep this agreement human — but a few standard legal provisions are necessary and we want to be upfront about them:

Governing Law: This agreement is governed by the laws of the State of Oregon. Disputes are resolved in Oregon courts.
Jurisdiction — Alaska Patients: Services provided under Dr. McGowan's Alaska license may be subject to Alaska law where applicable. Please let us know if you are an Alaska-resident patient.
Change of Law: If any law changes in a way that affects this agreement, we'll update only what’s needed to stay compliant.
Entire Agreement: This document is the complete agreement between us. It replaces anything we may have discussed informally.
Severability: If any one part of this agreement is found unenforceable, the rest remains in effect.
No Waiver: If we don’t enforce something in a given situation, that doesn’t mean we’ve given it up permanently.
Electronic Signature: Signing electronically through the Atlas MD platform or presencemd.com carries the same legal weight as a handwritten signature.
This Is Not an Emergency: By signing, you confirm you’re not in a medical emergency right now, and you’ve had the chance to read this and ask questions.

One more thing: We genuinely care about every patient we see. If something ever isn't working — a billing concern, a communication issue, anything — please come to us directly before posting a review or complaint. We promise to listen and make it right. We’re a small practice built on trust, and that matters deeply to us.




SIGNATURES

By signing below, both parties agree to the terms of this Patient Agreement.

For PresenceMD LLC:

Torree McGowan, MD: __________________________________________
Date: _________________________

Patient:

Printed Name: ________________________________________________

Signature: ________________________________________________
Date: _________________________


Questions? Reach us at presencemd.com or through the Atlas MD patient app.
PresenceMD LLC · Torree McGowan, MD · Oregon & Alaska Licensed