ContractPatient Member Agreement • February 3rd, 2023 • Oregon
This PATIENT MEMBER AGREEMENT (this “Agreement”) sets forth the terms and conditions pursuant to which you (“you” or “Patient”) will become a patient member of Ancora Counseling and Therapy Services, LLC, DBA Ancora Wellness (Ancora) under the Ancora Wellness Membership.
Patient Member Agreement – Individual or Family PlanPatient Member Agreement • April 23rd, 2021 • North Carolina
This PATIENT MEMBER AGREEMENT (this “Agreement”) sets forth the terms and conditions pursuant to which you (“you” or “Patient”) will become a patient member of Lantern Health, PLLC. (the “Clinic”) under the Lantern Membership. If your Type of Membership is for more than one person (e.g. for you and your spouse, your children under age 26, et cetera covered under the same Plan) then the term “you” or “Patient” as used in this Agreement shall include all family members accessing the Clinic under a single Membership.
El acuerdo de miembro del paciente español se incluye después de la última página en inglés. Kohl Direct Family Care PLLC PATIENT Member AGREEMENT This Patient Agreement (Agreement) is between Kohl Direct Family Care PLLCPatient Member Agreement • January 10th, 2023 • Texas
provides ongoing primary care medicine to its Members in a direct pay, membership model (DPC). In exchange for certain periodic fees, the Practice agrees to provide You with the Services described in this Agreement under the terms and conditions contained within.
