Terms of Service

Please read these Terms of Service carefully before using Elizabeth AI Receptionist services. They describe the service as it operates today; where something is planned but not yet in effect, they say so.

1.Acceptance of Terms

These Terms of Service ("Terms") are a contract between Elizabeth AI Receptionist LLC, a Texas limited liability company based in Dickinson, Texas ("Elizabeth AI", "we", "us"), and the medical practice or other organization that creates an account, completes checkout, or otherwise uses the Services ("you", "your practice"). By accessing or using the Services you agree to be bound by these Terms and you represent that you have authority to bind your practice.

Your agreement with us consists of: (1) these Terms; (2) the Business Associate Agreement between your practice and Elizabeth AI (the "BAA"), which you sign during onboarding before any protected health information is handled; (3) any other document you sign during onboarding, such as the Installation Cooperation Agreement; (4) the plan, prices and any written order confirmed at checkout; and (5) our Privacy Policy. If these Terms conflict with the BAA on anything concerning protected health information, the BAA controls.

Patients and callers. If you are a patient, caller or other member of the public who interacts with Elizabeth on behalf of a practice, that practice is responsible for your care and your records. Section 18 (SMS / Messaging Terms) applies to you if you receive text messages from us.

2.Description of Services

Elizabeth AI provides "Elizabeth", an artificial-intelligence voice receptionist, together with a patient check-in kiosk and a staff dashboard (together, the "Services"). Depending on your plan and onboarding, the Services include:

• Automated answering of calls to the phone number(s) assigned to your practice, 24 hours a day
• Appointment scheduling, rescheduling and cancellation, within the schedule Elizabeth keeps for your practice
• Prescription refill request collection (Elizabeth records the request for your staff; it does not approve, deny or send prescriptions)
• Answers to frequently asked questions, from information your practice supplies
• Taking a structured message for your staff when a request is outside Elizabeth's scope, and posting call outcomes to your dashboard and your staff notification channels
• Automated appointment confirmation and reminder text messages (SMS only; there are no automated voice-call reminders)
• Care-Gap outbound calling: outbound calls placed at your practice's direction, for the care-gap types you select, to patients on the roster you provide whom the Services flag as overdue for a follow-up, inviting them to schedule it and, where a scenario calls for it, asking for a patient-reported reading (such as a blood pressure or glucose value) that is relayed to your staff as reported; when repeated call attempts go unanswered, a follow-up text may be sent to a patient who has opted in to texts (Section 18)
• Patient self-check-in on a practice-provided tablet, including capture of insurance details when they are missing from your records
• A staff dashboard with call logs, call summaries, notifications and usage analytics

The Services are administrative. They do not provide medical, legal or financial advice, do not make clinical assessments, and do not verify insurance eligibility or coverage. Elizabeth is not an emergency service (Section 9).

Electronic health record (EHR) connections. Elizabeth AI holds developer (sandbox) registrations with Epic, athenahealth and Oracle Health. As of the Effective Date no practice's live EHR is connected. Unless and until an EHR connection is enabled for your practice in writing, Elizabeth keeps its own schedule and patient records for your practice inside the Services, reminder texts cover only appointments in that schedule (booked by Elizabeth or entered by your staff in the dashboard), not appointments that exist only in your EHR, and kiosk check-in records are stored in Elizabeth AI's database rather than sent to your EHR.

3.Your Responsibilities

You agree to:

• Provide accurate practice, provider, schedule and patient information, and keep it current
• Maintain human oversight of the AI and kiosk systems: review the dashboard, staff messages and outcome notifications regularly, and verify information Elizabeth or the kiosk collected before relying on it
• Comply with all laws that apply to you, including HIPAA and Texas Health and Safety Code Chapter 181, and sign the BAA before any protected health information is handled through the Services
• Obtain and document any consent your patients must give before being contacted, including consent required under the Telephone Consumer Protection Act and related rules for calls and text messages to mobile numbers that use an artificial or AI-generated voice or automated texting, and give us only patient contact numbers you are permitted to have us call or text
• Make the patient-facing disclosures that apply to your practice, including any required disclosure that your practice uses an artificial-intelligence system in connection with health care services (see Section 4)
• Keep your own emergency instructions in place and tell your patients how to reach a person for urgent needs (Section 9)
• Protect your login credentials, limit dashboard access to authorized staff, and tell us promptly when a staff member leaves
• Notify us promptly of any suspected security incident, unauthorized access or misuse of the Services
• Meet the technical requirements agreed at onboarding, including call forwarding from your practice line and a supported tablet for the kiosk
• Not use the Services unlawfully, or for telemarketing, debt collection or any purpose other than your practice's own patient communications

4.AI and Kiosk Disclosure

Elizabeth is an artificial-intelligence system. Callers and patients who speak with Elizabeth are interacting with software, not a person. Elizabeth speaks under the name "Elizabeth" and introduces herself as answering for, or calling from, your practice (for example, "Hi, this is Elizabeth calling from [practice name]"). As of the Effective Date, Elizabeth's standard outbound scripts do not add a separate statement that she is an automated system, and we have not yet confirmed whether her inbound greeting does. Your practice is responsible for deciding what disclosure your patients must receive — for example under Texas law on the use of artificial intelligence in health care, or under the federal rules that apply to calls made with an artificial voice — and for telling us the wording you require before go-live; we will include wording you require in the greeting and outbound scripts configured for your practice. We are adding an explicit automated-assistant statement to Elizabeth's standard scripts before any practice goes live.

Elizabeth may make mistakes. She may mishear a name, date or number, may misunderstand a request, and may occasionally produce an incorrect or incomplete response. Elizabeth is designed to read back what she heard and ask the caller to confirm it, but you must not treat anything Elizabeth records as verified until your staff has reviewed it.

The check-in kiosk collects patient information electronically on a tablet in your office and stores it in Elizabeth AI's database for your practice; it does not keep patient information on the tablet between sessions. Calls with Elizabeth are processed by our voice-AI provider, which receives the call audio and produces the transcript (Section 13). Elizabeth AI does not itself record call audio.

5.Fees and Payment

Plans. Fees depend on the plan you select: Solo $499/mo, Practice $1,149/mo, Group $2,399/mo, and Network from $6,999/mo. Plans are billed monthly in advance by card through Stripe, our payment processor. Annual billing is not currently offered. A one-time setup fee applies to every plan and is charged at checkout together with your first month: $3,500 for Solo, Practice and Group, and $5,000 for Network. The setup fee is non-refundable.

Allowances and overage rates. Each tier includes a single monthly minute allowance covering both inbound calls and Care-Gap outbound calls, plus an SMS allowance: Solo 1,200 minutes and 500 texts; Practice 3,000 and 2,000; Group 7,500 and 4,500; Network 25,000 and 12,000. All billed minutes are rounded up to the next whole minute per call. Calls detected as an answering machine, voicemail or fax, and connected calls shorter than six seconds, are not counted against your allowance. Usage above your allowance is charged at your tier's overage rates: $0.35, $0.30, $0.25 and $0.22 per minute for Solo, Practice, Group and Network respectively, and $0.01 per text message on every tier.

Overage is billed in arrears. At the end of each billing period, minutes and text messages over your allowance are added to your next monthly invoice as separate itemized lines (one for minutes, one for text messages), each showing the period, the quantity and the rate, and are charged to the card on file together with your subscription fee. There are no mid-cycle charges, prepaid minute blocks, usage deposits or prepaid credits. If a period's overage comes to less than $0.50 it is not invoiced that month and may be carried into a later invoice. If call records for a period reach our meter only after that period has been invoiced, the additional minutes are billed on a later invoice as a separate adjustment line at that period's rate. Your dashboard shows your current-period usage, and we send courtesy usage notices by email to your account owner as pooled minutes reach 80% and 100% of your allowance, at each further 25% step above it, and when your spending cap is reached. Those notices are a convenience; your dashboard and your invoice are the record of your usage.

Spending cap. Each subscription includes a default spending cap per billing period so that a runaway script cannot produce a surprise bill: 3× your base tier price for Solo and Practice, and 2× for Group and Network. You can set your own cap between 1.25× and 5× your base price from the dashboard. The cap is checked when a call starts or is dialed: once your base fee plus accrued overage reaches the cap, new inbound calls are declined with a short spoken message and outbound campaigns stop until you raise the cap or the period renews. Calls already in progress are never cut off, and they are billed. The cap is a safeguard, not a guarantee: if the check cannot run because of a system fault, calls are allowed through and their usage is billed.

Failed payments. If a renewal payment fails, Stripe retries the card on its schedule. While a payment is past due, outbound campaigns pause immediately; inbound answering continues for a grace period of seven days and is then declined until payment succeeds. If the retries are exhausted and the subscription is marked unpaid, your account is suspended and calls are declined until the balance is paid. While a card dispute (chargeback) is open, outbound campaigns pause and inbound answering continues.

Fee changes and taxes. We may change plan prices or overage rates no more than once per year, on at least 60 days' written notice to your billing contact. Fees exclude sales and similar taxes; where we are required to collect them we add them to your invoice. You authorize us and Stripe to charge the card on file for the fees described in these Terms.

6.Commencement of Fees

There is no free trial. Your monthly subscription fee begins at checkout, on the date your subscription is created. At checkout you are charged the first monthly subscription fee for the plan you selected and the one-time setup fee described in Section 5 ($3,500 for Solo, Practice and Group; $5,000 for Network), and your subscription bills monthly thereafter.

Fees are not deferred to go-live: the 4–6 week onboarding and go-live schedule neither delays nor reduces them. The setup fee is non-refundable. You may cancel at any time under Section 12; cancellation does not refund the setup fee or any monthly subscription fee already charged.

An account that has been created but has not completed checkout is not active. Such an account is limited to a small safety ceiling of usage per calendar month and cannot be used for live patient traffic.

7.Intellectual Property and Your Data

All technology, software, AI models, prompts, scripts, kiosk software and related intellectual property in the Services are the exclusive property of Elizabeth AI or its licensors. You receive a limited, non-exclusive, non-transferable license to use the Services during the agreement term for your practice's internal operations.

You retain ownership of your practice data and patient information. We use it only to provide and support the Services, to bill you, to meet our legal obligations, and as the BAA permits. Elizabeth AI does not sell protected health information and does not use your practice's data or protected health information to train or fine-tune AI models. Section 13 names the third-party providers that process data on our behalf and explains what we can and cannot yet warrant about their handling of it.

8.Restrictions

You may not reverse-engineer, decompile or disassemble any part of the Services. You may not resell, sublicense or share access to the Services with unauthorized third parties, or use the Services to build a competing product or service. You may not use the Services to place calls or send texts that you are not permitted by law to place or send, to contact anyone who has asked not to be contacted, or to upload data that you do not have the right to give us.

9.Disclaimers and Emergencies

The Services are provided as described in these Terms. While we strive for accuracy and reliability, AI systems may produce errors, and telephone and messaging delivery depend on carriers and third-party providers we do not control; we do not guarantee that every call will connect or every message will be delivered. Human oversight through regular dashboard review is required. The Services are administrative tools and do not constitute medical, legal or financial advice. Kiosk-collected data should be verified by staff.

Not an emergency service. Elizabeth is not monitored by clinicians and is not designed to identify or respond to emergencies. Elizabeth's outbound calling instructions direct her to tell a person who describes a medical emergency or severe symptoms to hang up and call 9-1-1; that is a safeguard, not a guarantee, and it does not apply to text messages or the kiosk. Your practice must keep its own emergency instructions in place, including in any greeting or hold message, and must not rely on Elizabeth to triage emergencies.

No clinical assessment. A reading a patient reports on an outbound call is relayed to your staff as the patient stated it. It is not a clinical measurement, and Elizabeth does not diagnose, assess or recommend treatment.

10.Limitation of Liability

To the fullest extent permitted by law, Elizabeth AI's total liability arising out of or relating to the Services shall not exceed the fees you paid in the twelve months preceding the claim. Neither party shall be liable for indirect, incidental, special or consequential damages, or for lost profits or lost revenue, even if advised of their possibility. Elizabeth AI is not liable for disruptions caused by your systems, your staff or your telephone carrier. Nothing in this section limits liability that cannot be limited under applicable law, and nothing in it changes either party's obligations under the BAA to the extent the BAA provides otherwise.

11.Indemnification

To the extent permitted by law, you will defend and indemnify Elizabeth AI from third-party claims arising from your use of the Services in breach of these Terms or the law, from inaccurate information you or your staff supplied, from contact with patients who had not given any consent the law required, and from clinical decisions made by your practice.

12.Term, Cancellation and Suspension

Term. Your subscription runs month to month from the checkout date and renews automatically each month until cancelled.

How to cancel. You may cancel at any time by emailing [email protected] from an authorized account contact. We confirm cancellation in writing within two business days, and cancellation takes effect immediately on our confirmation. We do not pro-rate or refund partial months, the setup fee, or any monthly fee already charged.

Termination for breach or cause. Either party may terminate for a material breach that remains uncured 30 days after written notice describing the breach. We may suspend or terminate the Services immediately on notice if your account is unpaid after the grace period in Section 5, if you use the Services unlawfully or in a way that threatens the security or integrity of the Services or the privacy of patient data, or if the law or the BAA requires us to.

What happens at termination. When your subscription ends, whether by cancellation or by termination under this Section, your account is marked cancelled, and from that moment, automatically: (a) the assigned number stops answering — a call to it is refused before it is answered, the caller hears the carrier's standard not-in-service message, no AI session starts, Elizabeth says nothing, and no conversation record or transcript is created (our hourly usage reconciliation still logs the attempt — the caller's number, the time and a zero duration — as a usage record, which is kept with the phone number removed when your data is deleted under Section 13); we release the assigned number afterwards unless you ask us in writing to port it, which is subject to carrier rules; (b) a text message sent to the assigned number is not stored or answered by us unless it is STOP, which is still honored, or HELP, which still receives the help reply — a YES or START reply no longer enrolls anyone (our messaging carrier still receives every text); (c) outbound Care-Gap campaign calls are no longer placed for your practice; (d) staff sign-in is refused — a password sign-in shows the message "This practice account is closed. Please contact support.", a Google or Microsoft sign-in returns to the sign-in page, and any dashboard session still open is ended at its next request — so your staff can no longer view records in the dashboard, and requests for your data go through us under Section 13; (e) outstanding charges — overage accrued to the termination date and any unpaid fees — are invoiced and charged to the card on file, subject to the note in Section 5 that overage invoicing is not yet in effect; and (f) your practice's data is handled as described in Section 13. Two things are not automatic: reminder texts for appointments still on your practice's schedule are not stopped by cancellation — ask us in writing and we turn them off by hand, and they end in any case when your data is deleted — and the number itself is released or ported by hand, as described in (a).

13.Data, PHI and the BAA

Roles. Your practice is the HIPAA covered entity and the owner of its patient records. Elizabeth AI acts as your business associate under the BAA whenever it creates, receives, maintains or transmits protected health information ("PHI") for you. As we read Texas Health and Safety Code Chapter 181, Elizabeth AI is also a "covered entity" as that chapter defines the term, and we treat its requirements as applying to us. Our Privacy Policy and HIPAA page describe our practices in more detail, including the safeguards that are not yet in place; the BAA controls for PHI.

Permitted uses. We use and disclose PHI only to provide the Services to your practice, for our own proper management and administration as the BAA allows, as required by law, and as you direct in writing. We apply the minimum-necessary standard, we do not sell PHI, and we do not use PHI for marketing.

What we hold. Depending on the features you use, the Services hold call summaries and the details Elizabeth records during calls (and, for calls made before mid-August 2026 on our earlier system, full transcripts); caller phone numbers, names and dates of birth used to verify identity; appointment details; refill requests; staff messages; patient-reported readings collected on outbound calls; text message contents; kiosk check-in and insurance details; and call, message and usage metadata. Elizabeth AI does not store call audio. Our own server and database are in the United States (Google Cloud, Iowa).

Providers that process data for us. We use the following third-party providers to deliver the Services. Each may receive PHI as noted.

• xAI (voice AI) — receives the audio of every inbound and outbound call and produces and retains the transcript
• Twilio (telephone and text carrier) — carries calls and text messages and retains call logs and message contents
• Google Cloud — hosts our server and database
• Cloudflare — proxies and terminates encryption for all web, API and webhook traffic, and can therefore see that traffic in the clear at its edge
• Microsoft (Power Automate, Teams and our company email) — delivers staff notification emails and Teams cards, which can include a patient's name, the call outcome and a patient-reported reading, and hosts our company mailboxes, so email your practice sends us is stored there
• Stripe — billing only; Stripe receives your practice's billing contact and card details and never receives PHI

Two further providers receive no PHI: Google Maps (when a caller names a pharmacy, its name and area are sent to look up the address; the caller's name and number are not) and SignNow (electronic signature of onboarding documents). Our Privacy Policy describes each provider in more detail.

Security incidents and breach notification. We will notify your practice of any use or disclosure of PHI not permitted by the BAA, any security incident affecting your PHI, and any breach of unsecured PHI, without unreasonable delay, within the time the BAA specifies and in any case no later than the outer limit set by 45 CFR 164.410, and we will give you the information you need to meet your own notification duties under HIPAA and Texas Business and Commerce Code Section 521.053. Report security concerns to [email protected] with the subject line URGENT.

Retention during the term. We keep your practice's data for as long as your subscription is active. There is currently no automatic deletion of transcripts, messages or other records during the term, and no per-practice retention setting. If you need specific records deleted earlier, ask us in writing and we will handle the request manually.

Return and deletion after termination. For 90 days after termination we keep your practice's data so that you can request an export and so that final billing can be completed. Within that window, on your written request, we will provide an export of your practice's records in a machine-readable format. After the 90 days we delete your practice's PHI from our production database using a retention process run by Elizabeth AI staff; deletion is not automatic, and we will confirm in writing when it is done. We keep: billing and usage records, with patient phone numbers and call identifiers removed; our audit log of the requests Elizabeth made to our server during calls and of the dashboard actions that are logged (staff sign-ins and record views are not yet logged), which can include a phone number or a medication name recorded with the action; records we are required to keep by law, including records that document a patient's text-message or calling consent or opt-out, for as long as the law requires; and database backups, which we do not restore to production after deletion except to recover from a failure. Copies of call audio, transcripts, call logs and message contents held by the providers listed above are subject to those providers' own retention practices; until the agreements described above are in place we cannot direct their deletion, which is one reason live patient traffic is paused. Where returning or destroying PHI is not feasible, we extend the BAA's protections to that PHI and limit its further use to the purposes that make return or destruction infeasible, as the BAA provides.

14.Force Majeure

Neither party shall be liable for delays or failures caused by events beyond its reasonable control, including natural disasters, internet or telephone-network outages, failures of third-party carriers, AI or cloud providers, or government actions. Payment obligations for Services already delivered are not excused.

15.Governing Law and Disputes

These Terms are governed by the laws of the State of Texas, without regard to its conflict-of-laws rules. Any dispute arising out of or relating to these Terms or the Services shall be resolved through binding arbitration in Houston, Texas under the rules of the American Arbitration Association, except that either party may bring an individual claim in small-claims court or seek a court order to protect its intellectual property or confidential information. Each party bears its own attorney fees unless the arbitrator awards otherwise.

16.Changes to Terms

We may update these Terms from time to time. For material changes we email your practice's primary contact at least 30 days before the change takes effect. If you do not agree to a change you may cancel under Section 12 before it takes effect; continued use of the Services after the effective date constitutes acceptance. Changes required by law, or that only add features or clarify wording, may take effect when posted.

17.Contact

18.SMS / Messaging Terms

These terms govern the text messaging programs operated by Elizabeth AI Receptionist LLC. Messages are sent from telephone numbers Elizabeth AI controls, either on behalf of a subscribing practice or for Elizabeth AI itself.

Program description. Two message programs run under this agreement:

• Practice patient messages — service messages sent to patients of a subscribing practice, identified by that practice's name and sent via Elizabeth AI Receptionist: appointment confirmations and reminders, cancellation and reschedule notices, refill request updates, a follow-up text when repeated outbound call attempts did not reach you, and the opt-in invitation and confirmations described below. These are not marketing messages.
• Demo updates — messages to prospective customers about a demo they requested, and related updates. To date, demo confirmations have gone by email and no demo texts have been sent to prospects.

How you join. Consent to receive text messages is not a condition of care, of purchase, or of any other service, and declining changes nothing about what you receive. You join in one of these ways:

• Practice patient messages — by ticking the consent checkbox, which is unchecked by default, on the practice's check-in kiosk; or by replying YES to an invitation text. When an appointment is booked for you — on a call with Elizabeth or by the practice's staff — Elizabeth AI sends a single invitation text to your mobile number asking you to reply YES to receive appointment texts (it may be sent again if another appointment is booked later and you have not replied). If you do not reply YES, you will not receive appointment texts.
• Demo updates — by ticking the consent checkbox, which is unchecked by default, on our demo request form.

Replying YES, START or UNSTOP to a message from us also opts you in. For each opt-in we keep the number, the date and time, where it happened, and the wording you saw or sent.

• Message frequency varies. There is no fixed number of messages; it depends on your scheduled appointments or demo.
• Message and data rates may apply. We charge nothing for messages; your mobile carrier may.
• Reply STOP to opt out of a program at any time. STOP is honored immediately and stops all texts from that program until you opt in again by replying YES or START. Telling Elizabeth during a call she placed to you that you do not want to be contacted stops that practice's outreach calls to you and the follow-up text those calls would otherwise trigger; on the current voice path it does not by itself stop appointment texts, so reply STOP to any text, or tell the practice, which can record an opt-out (or ask us to) that stops calls and texts together.
• Reply HELP for help. The help reply includes the practice's phone number. You can also email [email protected] or [email protected].
• Sending hours. Reminder and outreach texts are sent only between 8 a.m. and 9 p.m. U.S. Central Time (a practice can change the hours; a per-practice time zone is not yet applied). A text that follows something you just did — the invitation text after a booking, or a confirmation of a booking, cancellation, reschedule or refill request — is sent at the time you did it.
• Carriers are not liable for delayed or undelivered messages.
• Supported carriers include AT&T, T-Mobile, Verizon Wireless, Boost, Cricket, Metro by T-Mobile, U.S. Cellular, and most other U.S. wireless carriers. Carriers are not required to support the program, and support may change without notice.
• Eligibility. U.S. mobile numbers only. You must be the subscriber of, or authorized to use, the number you provide, and you must tell us when a number is no longer yours.

Outbound calls. Outbound campaign calls from Elizabeth are placed only to patients of a practice that has asked us to follow up with them, between 8 a.m. and 8 p.m. U.S. Central Time (these hours are set for the service as a whole today, not per practice) and never on Sundays. If you ask Elizabeth not to call again, we record a do-not-call for your number.

How opt-in data is handled — including our commitment that mobile opt-in data and consent are never shared or sold to third parties for marketing — is described in our Privacy Policy.