PATIENT AGREEMENTPatient Agreement • February 23rd, 2022 • Connecticut
Contract Type FiledFebruary 23rd, 2022 JurisdictionThis is an Agreement between Quiet Corner Family Practice, located at 697 Pomfret St, Pomfret, Connecticut, Kristen Xeller, M.D., (Physician) in her capacity as an agent of Quiet Corner Family Practice, and you, (Patient).