MCMASTER STUDENT WELLNESS CENTRE PATIENT AGREEMENTPatient Agreement • January 13th, 2023
Contract Type FiledJanuary 13th, 2023PLEASE SIGN BELOW TO INDICATE THAT YOU (THE PATIENT) UNDERSTAND AND ACCEPT THE TERMS OUTLINED ON PAGES 2, 3, AND 4. Signature Name on health card (first - middle - last) Date of birth (YYYY-MM-DD) Telephone number (### - ### - ####) McMaster email address Student number Program / faculty Date signed (YYYY-MM-DD)