Common Contracts
1 similar Provider-Patient Agreement contracts
254)228-0588 (O)Provider-Patient Agreement • February 25th, 2022
This Agreement is entered into by and between Balance Integrative & Infusion, LLC (“Balance Integrative”), a Texas Professional Association and Kelli Dudley, APRN, FNP- C (“Kelli Dudley”), and the undersigned patient (“Member”). Balance Integrative is a Direct Primary Care medical practice. Kelli Dudley is the owner and primary provider. Kelli Dudley practices family medicine and delivers care on behalf of Balance Integrative & Infusion at 6208 W Adams, Temple, Texas 76502, and also provides care via electronic communication and home visits. In exchange for the fees set out in this Agreement, Kelli Dudley at Balance Integrative and Infusion, LLC agree to provide Member the services set forth below. This agreement is entered into by mutual voluntary consent.
