DIRECT PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • August 8th, 2022 • Georgia
This is an Agreement between Prime Direct Care (Practice), a Georgia State LLC., located at 9070 Peridot Parkway, Stockbridge GA 30281. Bridget Randolph (Nurse Practitioner) in her capacity as an agent of Prime Direct Care, LLC and you, (Patient).
DIRECT PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • October 26th, 2020 • Oklahoma
This is an Agreement between REMEDY HEALTH, P.L.L.C. (“Practice”), an Oklahoma professional limited liability company and you, the patient (“Patient”).
Direct Primary Care Patient AgreementPrimary Care Patient Agreement • February 6th, 2019 • Tennessee
This is an Agreement between PATMOS EmergiClinic, Inc., (Practice), a Tennessee Corporation, located at 1231 Tusculum Blvd., Greeneville, TN 37745, Robert S. Berry, M.D. (Physician) in his capacity as an agent of PATMOS EmergiClinic, Inc. (whose name will change to DirectMD Greeneville), and (Patient). This Agreement is entered by mutual voluntary consent on , 20 .
DIRECT PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • December 17th, 2021 • Montana
This is an Agreement entered into on , 20 , between Eureka Family Health and Wellness, PLLC, a Montana Professional Limited Liability Company, (“the Practice”), and (“You” or “Patient”), residing at
Direct Primary Care Patient Agreement Addendum #1Primary Care Patient Agreement • May 25th, 2022
This is an Agreement between Boston Direct Health, PLLC (BDH) and you, the patient. This Addendum #1 DOES NOT supersede Patients Direct Primary Care Patient Agreement previously signed
DIRECT PRIMARY CARE PATIENT AGREEMENT KARRENBAUER INTEGRATIVE FAMILY MEDICINE, PLLC.Primary Care Patient Agreement • March 20th, 2022 • North Carolina
This is an Agreement between Karrenbauer Integrative Family Medicine, PLLC (Practice), a North Carolina PLLC, located at 200 Keisler Drive, Suite B, Cary, NC 27518. Camtu Nguyen Karrenbauer, D.O. (Physician) in her capacity as an agent of Karrenbauer Integrative Family Medicine, PLLC, and you, (Patient).
Direct Primary Care Patient AgreementPrimary Care Patient Agreement • July 31st, 2024
This Direct Primary Care-Patient Agreement (“Agreement”) specifies the terms and conditions under which, you, the undersigned patient (“Patient”) may participate in certain private direct health programs identified in the attached Schedule A (“Services”) offered by Hansen Medical LLC dba Simplified Health DPC Practice(“Practice”). (Patient and Practice are referred to individually as “Party” or collectively as “Parties”).
Grace Direct Primary Care Patient AgreementPrimary Care Patient Agreement • January 18th, 2023
This is an agreement between Grace Direct Primary Care (Grace DPC), a North Carolina corporation, located at 905 Halstead Blvd. Ste. 29, Elizabeth City, NC 27909, and you, the Patient.
DIRECT PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • March 31st, 2021 • Maine
This is an Agreement between LOCAL ROOTS HEALTH CARE, PLLC (“Practice”), a Maine professional limited liability company and you, the patient (“Patient”).
DIRECT PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • August 1st, 2019 • Oklahoma
This is an Agreement between REMEDY HEALTH, P.L.L.C. (“Practice”), an Oklahoma professional limited liability company, located at 5014 East 101st Street, Suite 200, Tulsa, Oklahoma 74137, [*Physician Name](“Physician”) in his capacity as an agent of Remedy Health, P.L.L.C. and you, [*Patient Name], (“Patient”).
DIRECT PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • September 15th, 2021
This is an Agreement between you (Patient) and Rodney R Story, MD, Timothy Matthew McCabe, MD, Lisa Halpert FNP, and/or Andrew Becker PA (Provider) in their capacity as an agent of Story Family Medicine, Inc. Story Family Medicine, Inc. (SFM) (Practice), an Idaho Corporation located at 1150 Alturas Drive #101, Moscow, Idaho.
PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • April 2nd, 2024 • Idaho
This is an Agreement between Josh Leavitt, DO(PHYSICIAN) in his capacity as owner and physician of Independent Family Doctors, LLC and sparkMD, LLC and You (PATIENT).
DIRECT PRIMARY CARE PATIENT AGREEMENT Shady Grove Direct Care, P.C.Primary Care Patient Agreement • December 26th, 2021 • Oregon
This is an Agreement between Shady Grove Direct Care, P.C. (Practice), Dr. Kimberly Cronin, M.D. (Dr. Cronin), and _____________________________ (Patient or Patient’s Representative for Patient, or You or Your).
DIRECT PRIMARY CARE PATIENT AGREEMENTPrimary Care Patient Agreement • November 7th, 2020 • Connecticut
This is an Agreement between Freedom Primary Care, LLC (Practice), a Connecticut LLC, located at 1224 Mill Street, Bldg B, East Berlin, CT 06023, Yvonne Joy, DNP, APRN
Direct Primary Care Patient Agreement Boston Direct Health, PLLCPrimary Care Patient Agreement • May 25th, 2022 • Massachusetts
The Clinic is a Direct Pay primary care practice (DPC), which delivers primary care services through its physicians, Dr. Steven Zivich (Physician). In exchange for certain fees, the Clinic agrees to provide YOU with the services described in this agreement on the terms and conditions contained in this agreement.
