Common Contracts

1 similar Patient Agreement contracts

MCMASTER STUDENT WELLNESS CENTRE PATIENT AGREEMENT
Patient Agreement • January 13th, 2023

PLEASE 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)

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