New Patient/Practice AgreementNew Patient/Practice Agreement • January 31st, 2017
Name Date of Birth Initial to indicate your understanding andagreement (print) Below: I = the Patient We = the Practice Disclosure I agree to disclose all material facts regarding my health to my General Practitioner and his/her clinical staff.We, the Practice, declare that we shall not disclose any information regarding you withoutyour written consent, unless required to do so by a court order or any other legal obligation. Confidentiality We declare that we shall hold confidential all matters pertaining to you and not releasesuch information, except in relation to managing your care (eg referral letter) without your written consent, unless required to do so by a court order or any other legal obligation. Evidence Based Medicine I understand and agree that Central Surgery clinicians practice evidence based medicine and assuch they may make changes to my existing treatment in order to optimise my health care. Appointments I agree to arrive on time for all appoin
New Patient/Practice AgreementNew Patient/Practice Agreement • January 24th, 2019
Name Date of Birth Initial to indicate your understanding andagreement (print) Below: I = the Patient We = the Practice Disclosure I agree to disclose all material facts regarding my health to my General Practitioner and his/her clinical staff.We, the Practice, declare that we shall not disclose any information regarding you withoutyour written consent, unless required to do so by a court order or any other legal obligation. Confidentiality We declare that we shall hold confidential all matters pertaining to you and not releasesuch information, except in relation to managing your care (eg referral letter) without your written consent, unless required to do so by a court order or any other legal obligation. Evidence Based Medicine I understand and agree that Central Surgery clinicians practice evidence based medicine and assuch they may make changes to my existing treatment in order to optimise my health care. Appointments I agree to arrive on time for all appoin
