PRIVATE CONTRACTPatient Contract • September 27th, 2021
This Agreement is between OneSkin Dermatology LLC (“Practice”), whose principal place of business is OneSkin Dermatology LLC 211 Grant Street Chambersburg, PA 17201, and patient (“Patient”), who resides at .
ALBERT EINSTEIN MEDICAL CENTER EINSTEIN BARIATRICS Patient Contract ALBERT EINSTEIN MEDICAL CENTER EINSTEIN BARIATRICS Patient ContractPatient Contract • October 25th, 2022
This contract is supported by Albert Einstein Medical Center and Einstein Bariatrics and will be effective and ongoing from the initial evaluation. The purpose of this Contract is to outline and document that I, _____________________ (name) understand and agree to follow all the instructions, protocols and directions before and after my surgery.
Patient Contract Patient ContractPatient Contract • July 23rd, 2023
This contract is supported by my surgeon, _______________, and will be effective and ongoing from the initial evaluation. The purpose of this Contract is to outline and document that I, _____________________ (name) understand and agree to follow all the instructions, protocols and directions before and after my surgery.
A Healthy Weigh Patient ContractPatient Contract • February 11th, 2022
Patient ContractPatient Contract • December 8th, 2015
I understand that if I am suffering from any medical conditions it is my responsibility to bring appropriate medication to each session eg inhalers, GTN spray, insulin. Failure to do so will result in the session being withdrawn for that day.
Patient ContractPatient Contract • March 2nd, 2010
This Patient Contract is provided to ensure that you fully understand that women of childbearing age who have had weight loss surgery must take special precautions in avoiding pregnancy for a designated period of time after weight loss. Weight loss due to bariatric surgery often increases fertility in those whom have had difficulty conceiving in the past. With that in mind, please complete following.
This Patient Contract ("Contract") is entered into between Complete Care Clinic, hereinafter referred toPatient Contract • March 14th, 2024 • Missouri
PATIENT CONTRACTPatient Contract • September 18th, 2019
APPOINTMENTS: Please see the late cancellation/no-show policy. All fees must be paid before future appointments can be scheduled.
PATIENT CONTRACTPatient Contract • September 25th, 2017
We are happy to have the pleasure of meeting your child’s dental needs at Dentistry for Children, PC. Please read carefully and sign the following agreement of terms in order to be accepted into our practice.
PATIENT CONTRACTPatient Contract • August 31st, 2015
At Athletic Orthopedic and Knee Center, we want you to benefit from your physical therapy as much as possible. Your therapist will provide you with education and treatments that will assist you in your recovery, but without your active participation and compliance with these exercises and attendance, full recovery may not be obtained. It is important for you to understand how critical your active involvement is in your recovery. Please take a moment to review this Patient Contract initial next to each statement and sign at the bottom.
Patient ContractPatient Contract • January 12th, 2017
• I understand that if I am suffering from any medical conditions it is my responsibility to bring appropriate medication to each session eg inhalers, GTN spray, insulin. Failure to do so will result in the session being withdrawn for that day.
