Common Contracts
1 similar Ancillary Services Agreement contracts
ANCILLARY SERVICES AGREEMENTAncillary Services Agreement • February 9th, 2019
This Ancillary Services Agreement (“Agreement”) is between [INSERT PRACTICE LEGAL NAME] (“We,” “Us,” or “Practice”) and the individual patient (or the parent/guardian of a patient) who has signed up either online or in paper copy for Ancillary Services to be rendered by the Practice. “Ancillary Services” consist of the services we render in connection with any of the following programs:
