CONCIERGE PRACTICE PATIENT AGREEMENTConcierge Practice Patient Agreement • October 1st, 2023 • Texas
, 20 , (the “Effective Date”) by and between Kevin B. Horton, M.D., FACP (“Physician”), in his capacity as Director of Kevin B. Horton, M.D., P.A. (“Practice”) and
Concierge Practice Patient AgreementConcierge Practice Patient Agreement • September 29th, 2022 • Texas
day of , 20 , (the “Effective Date”) by and among Erin A. Reese, MD (“Physician”), Erin Reese, MD, PLLC, a Texas Professional Limited Liability Company (“Practice”), and
CONCIERGE PRACTICE PATIENT AGREEMENTConcierge Practice Patient Agreement • December 4th, 2020 • Georgia
located at 410 Peachtree Parkway, Ste 4226 Cumming, GA 30041(Practice), Brent Carroll D.O, (Physician) in his capacity as an agent of Carroll Total Healthcare, and (Patient(s)).
CONCIERGE PRACTICE PATIENT AGREEMENTConcierge Practice Patient Agreement • March 11th, 2016 • California
The Physician delivers care on behalf ELLEN MCDONALD M.D. INC., at the address set forth above. In exchange for certain fees paid by You, ELLEN MCDONALD M.D. INC., through its Physician, agrees to provide Patient with the Services described in this Agreement on the terms and conditions set forth in this Agreement.
Concierge Practice Patient AgreementConcierge Practice Patient Agreement • March 12th, 2017 • Washington
You have decided to participate in concierge practice with Dr. Van Coevorden RVC Medical. This agreement describes the terms of your participation in the “Concierge Program.”
Tariq Ali Khan MD INC 14642 Newport Ave STE 408Concierge Practice Patient Agreement • March 19th, 2020 • California
The Physician delivers care on behalf Tariq Ali Khan M.D. INC., at the address set forth above. In exchange for certain fees paid by You, Tariq Ali Khan M.D. INC., through its Physician, agrees to provide Patient with the Services described in this Agreement on the terms and conditions set forth in this Agreement.
