Consent to Participate in BPC Program Sample Clauses

Consent to Participate in BPC Program. Each Patient must complete and sign this Agreement to join the BPC Program. Patient hereby acknowledges his/her decision to participate in BPC’s Program. Patient has the right to review and/or decline to sign this Agreement or to consult with and/or seek care from a different doctor. Patient has been advised that he/she may speak with the staff or the physician about this Agreement if he/she has any questions. Patient's signature below indicates that he/she has read this Agreement completely and has either had all of Patient's questions answered or acknowledges that Patient understands it and does not need to speak to anyone before signing this form. Patient understands that this is an important legally binding contractual agreement which may affect Patient's rights or the rights of the individual on whose behalf Patient is executing this contractual agreement. Patient requests services from BPC in full agreement with and understanding of the above. Patient is not relying on any oral representations by anyone employed by or affiliated with BPC in entering this Agreement and is signing of Patient's own free will. The undersigned Patient agrees to the terms of this Agreement, all of which are set forth herein. BPC has not made any promises, representations or guarantees except as set forth herein. The Parties have signed this Agreement as of the dates below.