MEMORANDUM OF UNDERSTANDING PRIVATE CONTRACT AGREEMENTPrivate Contract Agreement • February 9th, 2023
This Private Contract Agreement under the above referenced Transaction Code, is made and entered into on XX of FEBRUARY 2023 by and between the Parties identified as:
Private Contract AgreementPrivate Contract Agreement • September 24th, 2015
This contract between Prosthodontics Intermedica (“Dentist”) and (Insurance beneficiary, referred to in this contract as “Patient”) allows Dentist to provide treatment to Patient without being subject to insurance limits.
Private Contract AgreementPrivate Contract Agreement • February 13th, 2017
This contract between Prosthodontics Intermedica (“Dentist”) and (Insurance beneficiary, referred to in this contract as “Patient”) allows Dentist to provide treatment to Patient without being subject to insurance limits.
PRIVATE CONTRACT AGREEMENT – MEDICARE PARTICIPANTSPrivate Contract Agreement • November 3rd, 2010
The purpose of this contract is to ensure your understanding that the health care providers at the Wycoff Wellness Center have “opted out” of Medicare participation and by receiving services at the Wycoff Wellness Center you have entered into a private contract with the Wycoff Wellness Center. As such, we request that you read this document thoroughly prior to receiving any medical care at our location.
