Common Contracts
2 similar Patient Agreement contracts
PATIENT AGREEMENTPatient Agreement • October 19th, 2023
A minor child needs an Agreement signed by a parent or guardian. By signing the Agreement, the parent or guardian assumes responsibility for information on behalf of the patient. It is strongly recommended that a parent or guardian accompany a minor to all appointments. Minnesota Eye Consultants reserves the right to request identification of any adult accompanying a minor. In the event that a parent or guardian is unable to accompany a minor to an appointment, please contact us at 952-888-5800, in addition to signing this form.
PATIENT AGREEMENTPatient Agreement • June 22nd, 2016
A minor child needs an Agreement signed by a parent or guardian. By signing the Agreement, the parent or guardian assumes responsibility for information on behalf of the patient. It is strongly recommended that a parent or guardian accompany a minor to all appointments. Minnesota Eye Consultants reserves the right to request identification of any adult accompanying a minor. In the event that a parent or guardian is unable to accompany a minor to an appointment, please contact us at 952-888-5800, in addition to signing this form.
