Common Contracts
1 similar Private Practice Patient Agreement contracts
PAGING DR. NEIL / PANCHALMED, PC PRIVATE PRACTICE PATIENT AGREEMENTPrivate Practice Patient Agreement • May 7th, 2021
This Private Practice Patient Agreement (“Agreement”) specifies the terms and conditions under which, you, the undersigned patient (“Patient”) may voluntarily elect to participate in the healthcare offerings offered by PanchalMED PC, a New Jersey professional corporation (“Practice”), doing business as Paging Dr. Neil, which are summarized as follows: one-time routine regardless of medical condition or necessity diagnostic exam with a supportive health data communication plan. The routine regardless of medical condition or necessity diagnostic exam and Health Data Communication Plan are collectively referred to as the Practice’s private fee “Services.”
