Authorization and Agreement for Medical Services Sample Contracts

MRI ASSOCIATES OF SPRINGHILL, INC. AUTHORIZATION AND AGREEMENTS
Authorization and Agreement for Medical Services • February 11th, 2010

The undersigned hereby makes the following Acknowledgment and Agreement regarding the MRI/MRA/CT/X-Ray/Ultrasound/Mammography/DEXA services to be provided to the patient whose name appears above.

Sample 1
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