Medicina Del Sol (MDS) Direct Primary Care (Private Practice) Private Practice- Patient AgreementPrivate Practice-Patient Agreement • November 13th, 2020 • New Mexico
Please check here if responsible party information is same as patient ( Responsible Party and Patient(s) are collectively referred to as “Patient” in this Agreement.)
HEALING GROVE HEALTH CENTER PRIVATE PRACTICE PATIENT AGREEMENTPrivate Practice Patient Agreement • February 22nd, 2020
This Private Practice Patient Agreement (“Agreement”) specifies the terms and conditions under which, you, the undersigned patient (“Patient”) may voluntarily elect to participate in Practice’s Christian-based private direct primary healthcare practice with other related support and educational services all identified in the attached Schedule A (“Services”) offered by Healing Grove Health Center (“Practice”). (Patient and Practice are referred to individually as “Party” or collectively as “Parties”).
FIRSTCHOICE FAMILY MEDICINE PRIVATE PRACTICE-PATIENT AGREEMENTPrivate Practice-Patient Agreement • March 13th, 2020
This Private Practice-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 Thy Nguyen MD LLC d/b/a FirstChoice Family Medicine (“Practice”). (Patient and Practice are referred to individually as “Party” or collectively as “Parties”).
PAGING DR. NEIL / PANCHALMED, PC PRIVATE PRACTICE PATIENT AGREEMENTPrivate Practice Patient Agreement • May 7th, 2021
This Private Practice Patient Agreement (“Agreement”) specifies the terms and conditions under which, you, the undersigned patient (“Patient”) may voluntarily elect to participate in the healthcare offerings offered by PanchalMED PC, a New Jersey professional corporation (“Practice”), doing business as Paging Dr. Neil, which are summarized as follows: one-time routine regardless of medical condition or necessity diagnostic exam with a supportive health data communication plan. The routine regardless of medical condition or necessity diagnostic exam and Health Data Communication Plan are collectively referred to as the Practice’s private fee “Services.”
CALIFORNIA CENTER FOR FUNCTIONAL MEDICINE PRIVATE PRACTICE PATIENT AGREEMENTPrivate Practice Patient Agreement • December 28th, 2023
This Private Practice Patient Agreement (“Agreement”) specifies the terms and conditions under which, you, the undersigned patient (“Patient”) may voluntarily elect to participate in the healthcare offerings made available by
