Demographic Information. We rely on our patients to keep us up to date with your family's personal information. It is your responsibility to contact our office should any of the following change: Home address (No P.O. Box information will be accepted without a valid home address.), current phone numbers for both parents, and Emergency contact information.
Appears in 3 contracts
Samples: Responsibility Agreement, Responsibility Agreement, Responsibility Agreement
Demographic Information. We rely on our patients to keep us up to up-to-date with your family's personal information. It is your responsibility to contact our office should any of the following change: Home address (No P.O. Box information will be accepted without a valid home address.), current phone numbers for both parents, and Emergency contact information.
Appears in 2 contracts
Samples: Patient Responsibility Agreement, Responsibility Agreement
Demographic Information. We rely on our patients to keep us up to date with your family's personal information. It is your responsibility to contact our office should any of the following change: Home address (No P.O. Box information will be accepted without a valid home address.), current phone numbers for both parents, and Emergency contact information.
Appears in 1 contract
Samples: delawarepeds.com
