Maryann Simpson, NP.Patient Conditions of Treatment and Informed Consent to Treat • July 6th, 2017
This document is a binding agreement (the “Agreement”) between Maryann Simpson, NP (NP defined as Nurse Practitioner) and the individual patient whose name and signature appears below (“You” “Your”). In consideration of the health care services which may be provided to you by Maryann Simpson, NP at the present and at all times in the future. You agree as follows (your agreement indicated by placing your initials on the lines following each section and by signing in the space provided):
Dr. Laurie Blanscet, D.O.Patient Conditions of Treatment and Informed Consent to Treat • June 16th, 2020 • California
This document is a binding agreement (the “Agreement”) between Dr. Laurie Blanscet, D.O., (“We” “Us”) and the individual patient whose name and signature appears below (“You” “Your”). In consideration of the heath care services provided to You by Us at the present and at all times in the future, You agree as follows (Your agreement indicated by placing Your initials on the lines following each section and by signing in the space provided):
