Retroactive Effect. If patient intends this agreement to cover services rendered before that it is signed (for example, emergency treatment), patient should initial here . Effective as of the date of first professional services.
Appears in 1 contract
Sources: Arbitration Agreement
Retroactive Effect. If patient intends this agreement to cover services rendered before that the date it is signed (for example, emergency treatment), ) patient should initial here here. Effective as of the date of first professional services.
Appears in 1 contract
Sources: Arbitration Agreement
Retroactive Effect. If patient intends this agreement to cover services rendered before that the date it is signed (for example, emergency treatment), patient should initial here here: . Effective as of the date of first professional services.
Appears in 1 contract
Sources: Arbitration Agreement
Retroactive Effect. If patient intends this agreement to cover services rendered before that the date it is signed (for example, emergency treatment), patient should initial here here. Effective . Ef- fective as of the date of first professional services.
Appears in 1 contract
Sources: Arbitration Agreement
Retroactive Effect. If patient intends this agreement to cover services rendered before that the date it is signed (for example, emergency treatment), ) patient should initial here here. __________. Effective as of the date of first professional services.
Appears in 1 contract
Sources: Arbitration Agreement
Retroactive Effect. If a patient intends this agreement to cover services rendered before that the date it is signed (for example, emergency treatment), ) patient should initial here here: _____. Effective as of the date of first professional services.
Appears in 1 contract
Sources: Arbitration Agreement
Retroactive Effect. If patient intends this agreement to cover services rendered before that the date it is signed (for example, emergency treatment), ) patient should initial here here. . Effective as of a s the date of first professional services.
Appears in 1 contract
Sources: Arbitration Agreement