PRIVATE MEDICAL PRACTICE AGREEMENTPrivate Medical Practice Agreement • September 25th, 2020 • California
Street Address: City, State, Zip: Phone Numbers: (home): (mobile): Mailing address: City, State, and Zip: Social Security Number of Primary Patient:
PRIVATE MEDICAL PRACTICE AGREEMENTPrivate Medical Practice Agreement • September 17th, 2013
This Private Medical Practice Agreement sets forth the Setzer Personal Physicians LLC's Medical Practice Program’s terms and conditions of your participation. We refer to our services in this Agreement as "the Program." If you have any questions, please contact us at (717) 724-0290. Otherwise, please sign and date this Agreement, provide the information requested below, and return the Agreement to Setzer Personal Physicians, LLC, 645 North 12th Street Suite 300 Lemoyne, PA 17043.
