Common use of Retroactive Effect Clause in Contracts

Retroactive Effect. If patient intends this agreement to cover services rendered before the date it is signed (including, but not limited to, emergency treatment) patient should initial below: (Effective as of the date of first medical services) Patient’s or Patient Representative’s Initials If any provision of this arbitration agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreement.

Retroactive Effect. If patient intends this agreement to cover services rendered before the date it is signed (including, but not limited to, to emergency treatment) patient should initial below: (acknowledges by signing in office paperwork. Effective as of the date of first received medical services) Patient’s or Patient Representative’s Initials service. If any provision of this arbitration agreement is held invalid or unenforceable, the remaining provisions shall remain in full force forced and shall not be affected by the invalidity of any other provision. I have read and understand the arbitration agreement provided to me in office. I also understand that I have the right to receive a copy of this the arbitration agreementagreement which will be provided upon request.

Retroactive Effect. If patient intends this agreement Agreement to cover services rendered before the date it is signed (including, but not limited to, emergency treatment) patient should initial below: (; Effective as of the date of first medical services) services Patient’s 's or Patient Patient's Representative’s 's Initials If any provision of this arbitration agreement Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreementArbitration Agreement.

Retroactive Effect. If patient intends this agreement Agreement to cover services rendered before the date it is signed (includinginc luding, but not limited to, emergency treatment) patient should initial below: (; Effective as of the date of first medical services) services Patient’s 's or Patient Patient's Representative’s 's Initials If any provision of this arbitration agreement Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreement.Arbitration Agreement. Signature __ _ __ Date _ _ _

Retroactive Effect. If patient intends this agreement to cover services rendered before the date it is signed (including, but not limited tofor example, emergency treatment) patient should initial below: (here _. Effective as of the date of first medical professional services) Patient’s or Patient Representative’s Initials . If any provision of this arbitration agreement Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreementArbitration Agreement.

Retroactive Effect. If patient intends this agreement to cover services rendered before the date it is signed (including, but not limited tofor example, emergency treatment) patient should initial below: (here. . Effective as of the date of first medical professional services) Patient’s or Patient Representative’s Initials . If any provision of this arbitration agreement Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreementArbitration Agreement. By my signature on reverse, I acknowledge that I have received a copy.

Retroactive Effect. If patient intends this agreement to cover services rendered before the date it is signed (including, but not limited tofor example, emergency treatment) ), patient should initial below: (here. . Effective as of the date of first medical professional services) Patient’s or Patient Representative’s Initials . If any provision of this arbitration agreement Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreementArbitration Agreement. By my signature below, I acknowledge that I have received a copy.

Retroactive Effect. If patient intends this agreement to cover services rendered before the date it is signed (including, but not limited to, emergency treatment) patient should initial below: (Effective as of the date of the first medical services) services Patient or Patient’s or Patient Representative’s Initials If any provision of this arbitration agreement argument is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreement.

Retroactive Effect. If patient intends this agreement to cover services rendered before the date it is signed (including, but not limited to, to emergency treatmentservices) patient should initial belowhere: (Effective as of the date of first medical services) Patient’s or Patient Representative’s Initials . If any provision of this arbitration agreement is held determined to be invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this arbitration agreementforce.