ContractIndiana • January 6th, 2023
Jurisdiction FiledJanuary 6th, 2023Patient acknowledges that execution of this Services Agreement is an application to join Fountain Square Holistic Family Medicine, LLC, medical practice as a Patient. Fountain Square Holistic Family Medicine, LLC, in its sole discretion, may accept or reject any Patient at any time for any reason. If Patient is accepted by Fountain Square Holistic Family Medicine, LLC, this Agreement shall govern the ensuing business relationship.
ContractIndiana • November 26th, 2022
Jurisdiction FiledNovember 26th, 2022Patient acknowledges that execution of this Services Agreement is an application to join Fountain Square Holistic Family Medicine, LLC, medical Practice as a Patient. Fountain Square Holistic Family Medicine, LLC, in its sole discretion, may accept or reject any Patient at any time for any reason. If Patient is accepted by Fountain Square Holistic Family Medicine, LLC, this Agreement shall govern the ensuing business relationship.