Common Contracts
1 similar Consent and Financial Agreement contracts
Consent, Financial Agreement and Office PoliciesConsent and Financial Agreement • May 17th, 2017
The undersigned authorizes the medical providers at NorCal Endocrinology & Internal Medicine to provide medical, surgical and laboratory and radiology services deemed necessary for the treatment of illness or injury. The undersigned also authorizes the medical providers at NorCal Endocrinology & Internal Medicine to provide emergency medical treatment in the event of a medical emergency when the undersigned is unable to personally consent to treatment. The undersigned also agrees to be responsible for any charges associated with this emergency care including, but not limited to, transporting patient to the nearest hospital.
