Patient Relationship Agreement Sample Contracts

KB Health Online Clinic and Patient Relationship Agreement
Patient Relationship Agreement • November 6th, 2023

KB Health Online is a virtual care clinic providing primary care to patients who do not have a family doctor or family nurse practitioner. We are a multi-disciplinary team including nurse practitioners, registered nurses, social worker, and patient services coordinator.

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PATIENT RELATIONSHIP AGREEMENT FORM
Patient Relationship Agreement • September 16th, 2013

Treatment Relationship: I agree to medical care, treatment and diagnostic testing as directed by the treating physician or his/her designee. Baylor College of Medicine (BCM) is a teaching institution and may have students and residents involved in my care. I may request and receive information on the specific affiliation of any healthcare provider involved in my care.

PATIENT RELATIONSHIP AGREEMENT
Patient Relationship Agreement • February 28th, 2024

Treatment Relationship: I agree to medical care, treatment and diagnostic testing as directed by the treating physician or his/her designee. Baylor College of Medicine (BCM) is a teaching institution and may have students and residents involved in my care. I may request and receive information on the specific affiliation of any healthcare provider involved in my care.

PATIENT RELATIONSHIP AGREEMENT
Patient Relationship Agreement • October 19th, 2020

Treatment Relationship: I agree to medical care, treatment and diagnostic testing as directed by the treating physician or his/her designee. Baylor College of Medicine (BCM) is a teaching institution and may have students and residents involved in my care. I may request and receive information on the specific affiliation of any healthcare provider involved in my care.

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