ContractServices Agreement • January 6th, 2023 • Indiana
Contract Type FiledJanuary 6th, 2023 JurisdictionPatient 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.
ContractServices Agreement • November 26th, 2022 • Indiana
Contract Type FiledNovember 26th, 2022 JurisdictionPatient 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.