Examples of Patient Patient in a sentence
If this Agreement is held to be invalid for any reason, and if Practice is therefore required to refund all or any portion of the monthly fees paid by Patient, Patient agrees to pay Practice an amount equal to the fair market value of the Services actually rendered to Patient during the period of time for which the refunded fees were paid.
By signing this form, I authorize this agreement to remain in effect until the expiration of the credit card account and understand that I may revoke this authorization at any time by submitting a written request.Printed Name of Patient: Patient Signature: Date: Credit Card Authorization FormPlease complete all fields.
Should Therapist be subpoenaed, or ordered by a court of law, to appear as a wit- ness in an action involving Patient, Patient agrees to reimburse Therapist for any time spent for preparation, travel, or other time in which Therapist has made him/herself available for such an appearance at Therapist’s usual and customary hourly rate of $200.00.
If this Agreement is held to be invalid for any reason, and if Direct Doctors is therefore required to refund all or any portion of the monthly fees paid by Patient, Patient agrees to pay Direct Doctors an amount equal to the reasonable value of Services actually rendered to Patient during the period of time for which the refunded fees were paid.
Print Name of Patient Patient Date of Birth Signature of Patient or Patient’s Legal Representative Date(Please keep for your records.
I have answered all questions posed to me by the Patient (Patient Representative).
Should Therapist be subpoenaed, or ordered by a court of law, to appear as a witness in an action involving Patient, Patient agrees to reimburse Therapist for any time spent for preparation, travel, or other time in which Therapist has made him/herself available for such an appearance at Therapist’s usual and customary hourly rate.
Should Therapist be subpoenaed, or ordered by a court of law, to appear as a witness in an action involving Patient, Patient agrees to reimburse Therapist for any time spent for preparation, travel, or other time in which Therapist has made him/herself available for such an appearance at Therapist’s usual and customary hourly rate of $95.00 an hour.
The Patient (Patient Representative) has acknowledged understanding the nature of the procedure with the risks and benefits and has consented to the procedure.
Should Therapist be subpoenaed, or ordered by a court of law, to appear as a witness in an action involving Patient, Patient agrees to reimburse Therapist for any time spent for preparation, travel, or other time in which Therapist has made him/herself available for such an appearance at Therapist’s usual and customary hourly rate of $120.00.