FAMILY GUIDANCE CENTER OF WARREN COUNTY CLIENT AGREEMENT FOR SERVICEClient Agreement for Services • June 8th, 2021
Please read this form carefully. This Client Agreement for Services form requires your signed acknowledgement and agreement in order to receive services at the Family Guidance Center.
CLIENT AGREEMENT FOR SERVICESClient Agreement for Services • March 20th, 2019
Our Pharmacy has been chosen to provide pharmacy services at _Assisted Living Facility, we will be working with your facility in providing and managing your medications while staying in the facility. PharmcareUSA pharmacies kindly ask that you sign this form to ensure that we remain in compliance with Medicare and all other governing agencies. By execution of this Agreement, I consent and/or elect PharmcareUSA as my primary pharmacy to provide my pharmacy services and understand that PharmcareUSA accepts Medicare and Medicaid business.
CLIENT AGREEMENT FOR SERVICESClient Agreement for Services • March 20th, 2019
Our Pharmacy has been chosen to provide pharmacy services at _Nursing Facility, we will be work ing with your facility in providing and managing your medications while staying in the facility. PharmcareUSA pharmacies kindly ask that you sign this form to ensure that we remain in compliance with Medicare and all other governing agencies. By execution of this Agreement, I consent and/or elect PharmcareUSA as my primary pharmacy to provide my pharmacy services and understand that PharmcareUSA accepts Medicare and Medicaid business.
Client Agreement for Services, Disclosures & Consent for Treatment for Healing Touch SessionsClient Agreement for Services • February 23rd, 2021
