Independent Provider Agreement

🟣 Independent Provider Agreement

Effective Date: [Insert Date]

This Agreement is entered into by and between The Academic Gym® (“TAG”), a nationally credentialed therapy provider network, and the undersigned Independent Provider (“Provider”), collectively referred to as “the Parties.”

 

🔶 1. Purpose

TAG certifies and supports licensed professionals in delivering TAG VITAAL-K Therapy™ under a structured, branded framework. This Agreement outlines the terms under which Provider may deliver services using TAG’s infrastructure, branding, and referral systems.

 

🔶 2. Provider Status

Provider shall operate as an independent contractor and not as an employee, partner, or agent of TAG. Nothing in this Agreement shall be construed to create an employment relationship.

 

🔶 3. Certification & Scope of Services

Provider must complete TAG’s certification process and adhere to all fidelity tools, strand-based routines, and documentation protocols. Services may be delivered in schools, clinics, homes, or online, depending on licensure and client needs.

 

🔶 4. Costs and Compensation

4.1 Hourly Rate Structure

Provider shall set their own posted hourly rate for services delivered under TAG’s credentialed framework.

4.2 Referral-Based Bookings

When a client is referred by TAG or booked through TAG’s platform—and payment is processed through TAG’s system—the following fee structure applies:

• Provider retains 75% of the posted hourly rate

• TAG retains 25% as a platform and referral fee

4.3 Direct Payment by TAG

In certain cases, TAG may contract directly with clients, institutions, or payers. When services are delivered under such contracts, Provider shall be compensated at a fixed rate of $75 to $120 per session, as specified in the engagement terms. No platform fee shall apply in these scenarios.

4.4 Payment Processing

TAG shall process payments and remit Provider’s portion within [X] business days. Provider is responsible for applicable taxes and must submit a W-9 or equivalent documentation.

 

🔶 5. Intellectual Property

All TAG materials—including strand wheels, fidelity tools, branding assets, and training modules—remain the sole property of TAG. Provider is granted a limited, non-transferable license to use these materials solely for TAG-related services.

 

🔶 6. Confidentiality & Privacy

6.1 Confidential Information

Provider agrees to maintain strict confidentiality regarding all non-public TAG materials, client data, operational protocols, and proprietary routines.

6.2 Privacy Assurance

TAG complies with all applicable federal and state privacy regulations, including FERPA, COPPA, and NIST SP 800-171. Provider agrees to uphold these standards and protect all client and institutional data with care and integrity.

6.3 Data Handling

Provider shall not store, transmit, or disclose client information outside of TAG’s approved systems. Any breach or suspected breach must be reported immediately.

 

🔶 7. Non-Solicitation

Provider agrees not to solicit TAG clients, families, or team members for non-TAG services during the term of this Agreement and for 24 months thereafter.

 

🔶 8. Licensing Renewal & Fidelity

8.1 Annual Renewal Requirement

Provider’s certification shall be renewed annually, contingent upon completion of fidelity audits or self-attestation.

8.2 Audit Triggers

TAG reserves the right to initiate a fidelity audit at any time if concerns arise or if service formats expand.

8.3 Renewal Outcomes

Failure to complete renewal requirements may result in suspension or termination of certification.

 

🔶 9. Term & Termination

This Agreement shall remain in effect until terminated by either party with 30 days’ written notice. TAG reserves the right to terminate immediately in cases of breach, misconduct, or failure to maintain licensure.

 

🔶 10. Governing Law

This Agreement shall be governed by the laws of [Insert State].

 

Signature

Provider Name: ____________________

Date: ____________________

Authorized TAG Representative: ____________________