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By filling out this contract form and accepting the terms and conditions, you are entering into an agreement to become a client of Teesside Health Co’s Platinum Wellbeing EAP.

Name

First Name

Last Name

Email

Phone

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Company Name

This contract binds the business name above and Teesside Health Co, for the term of 12 months to carry out Employee assistance services for the company and its Employees. Terms & Conditions 1. Teesside Health Co will Sign up all employees to the Proactive EAP and Platinum Wellbeing Application developed by Teesside Health Co. 2. Teesside Health Co will carry out communications to employees of your company each month in order to encourage usage of the service. 3. Users of the Proactive Employee Assistance Program will be entitled to; - X2 free sessions of each private health service we offer which includes Counselling, Mental health coaching, personal training, physiotherapy and health coaching. - X8 sessions of each private health service we offer to the value of 65% discounted which includes Counselling, Mental health coaching, personal training, physiotherapy and health coaching. - Unlimited sessions of each private health service we offer to the value of 25% discounted which includes Counselling, Mental health coaching, personal training, physiotherapy and health coaching. Payment Terms 1. Your company (name entered above in form) will pay Teesside Health Co for every employee signed up to the Proactive EAP. This payment is repeated monthly. 2. Payments are collected on the 1st of every month via direct debit for the term of the contract. If terms of the contract are broken 1. In the event where the terms and conditions of the contract are broken or the contract is ceased, any payments for work carried out leading up to the event are non refundable. 2. If the terms and conditions of the contract are broken or ceased during the term of the contract, all data held by Teesside Health Co such as contact information and Platinum Wellbeing accounts will be deleted from our records for GDPR regulations. 3. If payments are missed and the second try of a direct debit isn’t met, a late payment fee will incur to the value of £30. This includes Platinum Wellbeing Charges and Consultancy Charges. By signing this document, you the client agree to the terms and conditions of this contract. Thank you for doing business with Teesside Health Co.

Terms and Conditions.

I Accept

Date

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DD

YYYY

I confirm I have authorisation to sign and accept this contract on behalf of the company name stated in the form.

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Sign up to our payment collections system. Payments are collected on the 1st of each month. Your payment will be the calculation of your headcount on the employee list submitted above, and the price agreed or accepted via your quotation. GoCardless is a safe and secure payment system, you will receive an invoice before the payment is taken each month for your records. Any changes to your headcount lasting longer than 6 months must be noted with us via email.

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