Purchase Order Dietitian in United States San Francisco –Free Word Template Download with AI
| Field | Details |
|---|---|
| Organization Name | Golden Gate Wellness & Nutrition Center, Inc. |
| Address | 1450 Market Street, Suite 820, United States San Francisco, CA 94102 |
| Contact Person | Ms. Angela Torres, Director of Client Services |
| Phone | (415) 555-0198 |
| [email protected] | |
| Tax ID / EIN | 94-2837461 |
| Field | Details |
|---|---|
| Professional Name | Dr. Marcus Chen, RD, LDN — Registered Dietitian |
| Practice Name | Chen Nutritional Consulting, LLC |
| Address | 780 Folsom Street, Floor 4, United States San Francisco, CA 94107 |
| Licensure | California Dietetic Association License No. CA-D-2019-44782 |
| Phone | (415) 555-0342 |
| [email protected] | |
| Tax ID / EIN | 87-5561203 |
This Purchase Order authorizes the engagement of a licensed Dietitian to provide comprehensive nutritional assessment, meal planning, and ongoing dietary counseling services to the client base of Golden Gate Wellness & Nutrition Center, Inc. All services shall be rendered in the United States San Francisco metropolitan area, specifically at the buyer's premises or at the Dietitian's registered practice location as mutually agreed upon in writing.
| Item # | Description of Dietitian Service | Qty | Unit | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 1 | Initial comprehensive nutritional assessment and metabolic panel review for each enrolled client (includes 90-minute consultation) | 45 | Session | $275.00 | $12,375.00 |
| 2 | Personalized dietary plan development including macro/micro-nutrient breakdown, allergen accommodation, and culturally appropriate meal suggestions tailored to the United States San Francisco community | 45 | Plan | $185.00 | $8,325.00 |
| 3 | Follow-up Dietitian consultation (60-minute session) for progress monitoring, plan adjustment, and client education | 90 | Session | $195.00 | $17,550.00 |
| 4 | Group nutrition workshop (2-hour session, up to 20 participants) covering topics such as Mediterranean diet, plant-based nutrition, and metabolic health | 6 | Workshop | $1,200.00 | $7,200.00 |
| 5 | Monthly written progress report and dietary compliance summary submitted to the buyer's medical director | 3 | Month | $850.00 | $2,550.00 |
| 6 | Emergency Dietitian availability (on-call, 4-hour response window) for acute dietary complications | 3 | Month | $400.00 | $1,200.00 |
| Subtotal | $49,200.00 | ||||
| California Sales & Use Tax (8.5%) | $4,182.00 | ||||
| TOTAL PURCHASE ORDER AMOUNT | $53,382.00 | ||||
- Scope of Engagement: The Dietitian shall perform all services in strict accordance with the California Code of Regulations, Title 16, Division 17, and the standards established by the Academy of Nutrition and Dietetics. The Dietitian must maintain current licensure in the State of California throughout the duration of this Purchase Order.
- Service Location: All in-person consultations, workshops, and client meetings shall take place within the United States San Francisco city limits or at the buyer's designated facility at 1450 Market Street. Remote telehealth sessions are permitted only with prior written approval from the buyer's Director of Client Services.
- Payment Schedule: Payment shall be made within thirty (30) calendar days of receipt of a valid invoice. Invoices must reference this Purchase Order number (PO-SF-2025-04872) and include a detailed itemization of services rendered. Late payments shall accrue interest at 1.5% per month as permitted under California Civil Code Section 3289.
- Confidentiality: The Dietitian shall comply with all provisions of the Health Insurance Portability and Accountability Act (HIPAA) and the California Confidentiality of Medical Information Act (CMIA). All client records, dietary data, and health information shall be stored securely and shall not be disclosed to any third party without explicit written consent from the client.
- Insurance and Liability: The Dietitian shall maintain professional liability insurance with a minimum coverage of $1,000,000 per occurrence and $2,000,000 in aggregate, naming Golden Gate Wellness & Nutrition Center, Inc. as an additional insured. A certificate of insurance shall be provided prior to the commencement of services.
- Termination: Either party may terminate this Purchase Order with thirty (30) days written notice. In the event of termination, the buyer shall pay for all services rendered up to the effective date of termination. The Dietitian shall return all client files and proprietary materials within ten (10) business days.
- Performance Standards: The Dietitian shall complete all initial assessments within five (5) business days of client enrollment. Follow-up sessions shall be scheduled within fourteen (14) days of the initial consultation. Failure to meet these timelines for more than two consecutive clients shall constitute a material breach of this Purchase Order.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of California. Any disputes arising hereunder shall be resolved through binding arbitration in the United States San Francisco, in accordance with the rules of the American Arbitration Association.
- Force Majeure: Neither party shall be liable for delays or failures in performance resulting from acts of God, natural disasters, pandemics, government orders, or other events beyond reasonable control, provided that the affected party notifies the other within forty-eight (48) hours of the occurrence.
By signing below, both parties acknowledge that they have read, understood, and agree to all terms, conditions, and specifications outlined in this Purchase Order for Dietitian services in the United States San Francisco area. This document constitutes a binding agreement effective as of the date of the last signature below.
For the Buyer:
Golden Gate Wellness & Nutrition Center, Inc.
Name: Angela TorresTitle: Director of Client Services
Signature: _________________________
Date: _________________________
For the Seller / Dietitian:
Chen Nutritional Consulting, LLC
Name: Dr. Marcus Chen, RD, LDNTitle: Principal Dietitian & Owner
Signature: _________________________
Date: _________________________ ⬇️ Download as DOCX Edit online as DOCX
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