{"component": "contracts", "props": {"contracts": [{"intro": "PERMISSION FOR EVALUATION AND TREATMENT: I hereby give permission to the professional staff of Pemi-Baker Community Health to perform any test(s) and give any treatment(s), deemed appropriate by the professional(s)", "id": "8hJsMK9UTZf", "source_url": "https://www.pemibakercommunityhealth.org/wp-content/uploads/2020/01/1-Neck-IE-Packet.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "November 27th, 2020", "published": true, "pretty": null, "uri": "/contracts/8hJsMK9UTZf", "title": "PATIENT AGREEMENT", "group_id": "7PRLfEh5tTa", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/8hJsMK9UTZf", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/7PRLfEh5tTa", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}]}, {"intro": "The Practice, located at 6 East 9th Suite 302, Columbia Falls, Montana 59912, provides ongoing primary care to its Members in a direct pay care model (DPC). In exchange for certain periodic fees, the Practice agrees to provide the Member with the Services described in this Agreement under the terms and conditions contained within.", "id": "7fIRcAe8im8", "source_url": "https://hometowncliniccfalls.com/wp-content/uploads/2023/12/Patient-Agreement.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "December 4th, 2023", "published": true, "pretty": null, "uri": "/contracts/7fIRcAe8im8", "title": "Patient Agreement", "group_id": "7fIRcAe8im8", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/7fIRcAe8im8", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/9gnjVxvOGc3", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Montana", "type": "jurisdiction", "uri": "/contracts/tagged/montana-us"}]}, {"intro": "As a participant in the opiate dependence protocol for treatment of opioid abuse and dependence, I free and voluntarily agree to accept this treatment agreement/contract, as follows:", "id": "dENdpeVccxA", "source_url": "https://ricardobierrenbach.com/wp-content/uploads/2020/05/Suboxone-Treatment-Agreement-May2020.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "May 20th, 2020", "published": true, "pretty": null, "uri": "/contracts/dENdpeVccxA", "title": "Patient Agreement to Participate in Opiate Dependence Treatment", "group_id": "7hihSx1lsNk", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/dENdpeVccxA", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/7hihSx1lsNk", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}]}, {"intro": "This is an Agreement between Fort Myers DPC, L.L.C., (\u201cFort Myers DPC\u201d), a Florida professional corporation, located at 4755 Summerlin Rd, For Myers, 33919, Florida, Nadezhda Gonzalez MD and Kivit Lima MD, (collectively \u201cPhysicians\u201d and singularly \u201cPhysician\u201d) in their capacity as agents of Fort Myers DPC, and you, Patient (\u201cpatient\u201d or \u201cyou\u201d):", "id": "8ewP13AmLCX", "source_url": "https://fortmyersdpc.com/wp-content/uploads/2021/07/PATIENT-AGREEMENT-Contract.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "May 6th, 2021", "published": true, "pretty": null, "uri": "/contracts/8ewP13AmLCX", "title": "PATIENT AGREEMENT", "group_id": "8ewP13AmLCX", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/d4m4wlHMAWk", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/8ewP13AmLCX", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Florida", "type": "jurisdiction", "uri": "/contracts/tagged/florida-us"}]}, {"intro": "This is an Agreement entered into on , 20 , by and between Pennington Primary Care, LLC, a South Carolina professional corporation, located at 197 Piedmont Blvd. Suite 110, Rock Hill, SC 29732 (Pennington Primary Care) and", "id": "h7tm4XTeCpa", "source_url": "https://sa1s3.patientpop.com/assets/docs/31982.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "March 12th, 2021", "published": true, "pretty": null, "uri": "/contracts/h7tm4XTeCpa", "title": "Patient Agreement", "group_id": "8mk3e2pJjnO", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/h7tm4XTeCpa", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/8mk3e2pJjnO", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "South Carolina", "type": "jurisdiction", "uri": "/contracts/tagged/south-carolina-us"}]}, {"intro": "Office Practice/Clinic personnel at this facility are hereby authorized to administer any medical, diagnostic or therapeutic treatment, as may be deemed necessary or advisable. I have the right to consent or refuse consent, to any proposed procedure or therapeutic course, absent emergency or extraordinary circumstances.", "id": "9884NgUuauX", "source_url": "https://www.stjohnhealthsystem.com/media/file/1326/Patient_agreement_form_English.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "April 14th, 2008", "published": true, "pretty": null, "uri": "/contracts/9884NgUuauX", "title": "PATIENT AGREEMENT", "group_id": "9884NgUuauX", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/jTINBI6l7s9", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/9884NgUuauX", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}]}, {"intro": "A minor child needs an Agreement signed by a parent or guardian. By signing the Agreement, the parent or guardian assumes responsibility for information on behalf of the patient. It is strongly recommended that a parent or guardian accompany a minor to all appointments. Minnesota Eye Consultants reserves the right to request identification of any adult accompanying a minor. In the event that a parent or guardian is unable to accompany a minor to an appointment, please contact us at 952-888-5800, in addition to signing this form.", "id": "iKVSHUifOmK", "source_url": "https://www.mneye.com/wp-content/uploads/1000-0076.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "October 19th, 2023", "published": true, "pretty": null, "uri": "/contracts/iKVSHUifOmK", "title": "PATIENT AGREEMENT", "group_id": "9O57z98Wsxb", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/iKVSHUifOmK", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/9O57z98Wsxb", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}]}, {"intro": "This Agreement contains important information about the professional services and business policies of The Leggett Group, LLC. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights with regard to the use and disclosure of your protected health information (PHI) used for the purpose of treatment, payment, and health care operations.", "id": "9SWyrunrTiu", "source_url": "http://theleggettgrouptherapy.com/wp-content/uploads/2014/03/TLG-patient-agreement.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "March 4th, 2014", "published": true, "pretty": null, "uri": "/contracts/9SWyrunrTiu", "title": "Patient Agreement and Notice of Privacy Practices", "group_id": "9SWyrunrTiu", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/9SWyrunrTiu", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/esM7PLLkviT", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}]}, {"intro": "The Practice delivers primary care medicine to patients in a direct pay primary care, membership model (DPC), at 514857 Highway 95, Bonners Ferry, Idaho 83805. In exchange for certain periodic fees, the Practice to provide the patient/member with the primary care services described in this Agreement, under the terms and conditions contained within.", "id": "9mAeNEPZArB", "source_url": "https://www.offgriddoc.com/wp-content/uploads/2021/09/Off-Grid-Doc-DPC-Patient-Agreement.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "September 21st, 2021", "published": true, "pretty": null, "uri": "/contracts/9mAeNEPZArB", "title": "DPC PATIENT AGREEMENT", "group_id": "9mAeNEPZArB", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/9mAeNEPZArB", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/ef5u3SejZJC", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Idaho", "type": "jurisdiction", "uri": "/contracts/tagged/idaho-us"}]}, {"intro": "This is an Agreement between Empower Family Medicine, L.L.C., a Georgia professional corporation, located at 209A Swanton Way Suite 101, Decatur, GA 30030, and you, (Patient, Principal). Melissa Black M.D. (Physician) serves as an agent of Empower Family Medicine (EFM). The person indicated as Principal agrees to assume financial responsibility for the Patients indicated.", "id": "aBgSblV7GVw", "source_url": "http://www.empowerdecatur.com/uploads/5/3/0/1/53016313/practice_agreement_form.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "June 14th, 2018", "published": true, "pretty": null, "uri": "/contracts/aBgSblV7GVw", "title": "EMPOWER FAMILY MEDICINE PATIENT AGREEMENT", "group_id": "aBgSblV7GVw", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/hYYRoYQx0Q", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/aBgSblV7GVw", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Georgia", "type": "jurisdiction", "uri": "/contracts/tagged/georgia-us"}]}, {"intro": "This Patient Agreement (Agreement) is between Integrate Internal Medicine, P.C. (the Practice, Us or We), and (Patient, Member or You).", "id": "aGrD6YmcV2N", "source_url": "http://integrateinternalmedicine.com/wp-content/uploads/2024/02/A.-2023_Foundational-Patient-Packet_Preview-Online_2_13_2024-copy.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "February 14th, 2024", "published": true, "pretty": null, "uri": "/contracts/aGrD6YmcV2N", "title": "INTEGRATE INTERNAL MEDICINE FOUNDATIONAL HEALTH - PATIENT AGREEMENT", "group_id": "aGrD6YmcV2N", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/aGrD6YmcV2N", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/lyIeTG9Gz4h", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Idaho", "type": "jurisdiction", "uri": "/contracts/tagged/idaho-us"}]}, {"intro": "This is an Agreement entered into on , 20__, by and between Jan Hester MD PC, a Colorado professional corporation located at 1120 E. Elizabeth St, Building G, Suite 1, Fort Collins, CO 80524 (Jan Hester MD PC), Jan Hester MD (Physician), in her capacity as an agent of Jan Hester MD PC and (Patient).", "id": "bhMTvqejvIU", "source_url": "https://janhestermd.com/wp-content/uploads/2015/12/WeightManagement_Agreement.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "October 29th, 2020", "published": true, "pretty": null, "uri": "/contracts/bhMTvqejvIU", "title": "PATIENT AGREEMENT (Weight Management) Jan Hester MD PC", "group_id": "bhMTvqejvIU", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/bhMTvqejvIU", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/d7tXPKGfrPf", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Colorado", "type": "jurisdiction", "uri": "/contracts/tagged/colorado-us"}]}, {"intro": "This is an Agreement between My Doc, L.L.C., a membership based Internal Medicine practice located at 721 South Orange Blossom Trail, Apopka, Florida 32703, and You (Patient) to receive medical services from a team of healthcare providers acting in their capacity as agents of My Doc, L.L.C.", "id": "iqdArFOgijs", "source_url": "https://s3-us-west-2.amazonaws.com/hint-api-production/document_versions/000/002/129/files/original.pdf?1577895578", "category_name": "Patient Agreement", "company_name": null, "created": "March 25th, 2021", "published": true, "pretty": null, "uri": "/contracts/iqdArFOgijs", "title": "PATIENT AGREEMENT FORM", "group_id": "bm9SUZCOhbx", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/iqdArFOgijs", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/bm9SUZCOhbx", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Florida", "type": "jurisdiction", "uri": "/contracts/tagged/florida-us"}]}, {"intro": "This Patient Agreement (Agreement) is between RESTORE WELLNESS AND MEDSPSA LLC. (the Practice, Us or We), and (Patient, Member, or You).", "id": "eJ9BwRmBBL5", "source_url": "https://cdn.prod.website-files.com/654ba6a53464c3d18957610d/66ace34857fcc0261cd0d956_Restore%20Wellness%20MedSpa%20Patient%20Agreementfinal%20080224.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "July 24th, 2024", "published": true, "pretty": null, "uri": "/contracts/eJ9BwRmBBL5", "title": "PATIENT AGREEMENT", "group_id": "bmJGt9jaZDf", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/bmJGt9jaZDf", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/eJ9BwRmBBL5", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Georgia", "type": "jurisdiction", "uri": "/contracts/tagged/georgia-us"}]}, {"intro": "This is an Agreement entered into on , 20 , between Kansas City Direct Primary Care, a Kansas Limited Liability Company (Clinic, Us or We), and", "id": "czbOZ8Ax0r9", "source_url": "https://kansascitydirectprimarycare.com/wp-content/uploads/2018/08/KCDPC_patient_agreement.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "September 16th, 2020", "published": true, "pretty": null, "uri": "/contracts/czbOZ8Ax0r9", "title": "PATIENT AGREEMENT", "group_id": "czbOZ8Ax0r9", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/czbOZ8Ax0r9", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/fSDodkO7I7f", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Kansas", "type": "jurisdiction", "uri": "/contracts/tagged/kansas-us"}]}, {"intro": "This is an agreement between Mulberry Clinics LLC, a Tennessee Limited Liability Company, located at 5328 Main St., Ste. K, Spring Hill, TN 37174 (Mulberry Clinics), and (print name of all patients on your Patient Registration Form)", "id": "d758ba20Qvz", "source_url": "https://firebasestorage.googleapis.com/v0/b/dpcspot.appspot.com/o/rthU9ttNuPQPs7402ozV0dw5NYU2%2FMULBERRY%20PATIENT%20AGREEMENT.pdf?alt=media&token=38cd0891-0833-45d0-ab4c-5b02f3c338b8", "category_name": "Patient Agreement", "company_name": null, "created": "January 14th, 2025", "published": true, "pretty": null, "uri": "/contracts/d758ba20Qvz", "title": "PATIENT AGREEMENT", "group_id": "d758ba20Qvz", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/d758ba20Qvz", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/jYyG88tZxuh", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Tennessee", "type": "jurisdiction", "uri": "/contracts/tagged/tennessee-us"}]}, {"intro": "The Practice, located at 5603 Newbury St., Baltimore, MD 21209 provides urgent care medicine to its Members in a direct pay, membership model (DPC). In exchange for certain periodic fees, the Practice agrees to provide You with the Services described in this Agreement under the terms and conditions contained within.", "id": "kP4mBWNsPGq", "source_url": "https://kidsfirstdpc.com/wp-content/uploads/2024/09/Patient-Agreement-Urgent-Care-Kids-First-DPC.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "September 23rd, 2024", "published": true, "pretty": null, "uri": "/contracts/kP4mBWNsPGq", "title": "PATIENT AGREEMENT \u2013 URGENT CARE", "group_id": "dHCT4avzWdf", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/kP4mBWNsPGq", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/dHCT4avzWdf", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Maryland", "type": "jurisdiction", "uri": "/contracts/tagged/maryland-us"}]}, {"intro": "This is an Agreement entered into on , 20 , between Doctor Direct, LLC, a North Carolina Limited Liability Company (Clinic, Us or We), and (Patient or You).", "id": "dg6cdQj0IYK", "source_url": "https://firebasestorage.googleapis.com/v0/b/dpcspot.appspot.com/o/ZGIxXRGiZIfl1EKi4bMhfQ8fs2y1%2FNEW%20PATIENT%20AGREEMENT%202018.%20pdf.pdf?alt=media&token=c06afe89-d896-416a-895a-39e35bfd14e3", "category_name": "Patient Agreement", "company_name": null, "created": "October 21st, 2021", "published": true, "pretty": null, "uri": "/contracts/dg6cdQj0IYK", "title": "PATIENT AGREEMENT DOCTOR DIRECT, LLC", "group_id": "dg6cdQj0IYK", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/dg6cdQj0IYK", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/jnyImtzX8gV", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "North Carolina", "type": "jurisdiction", "uri": "/contracts/tagged/north-carolina-us"}]}, {"intro": "This Patient Agreement (Agreement) is between Wellspring Direct Primary Care, PLLC (the Practice, Us or We), and (Patient, Member, or You).", "id": "dtO2GtHG9jE", "source_url": "https://s3-us-west-2.amazonaws.com/hint-api-production/document_versions/000/016/233/files/original.pdf?1621095719", "category_name": "Patient Agreement", "company_name": null, "created": "May 15th, 2021", "published": true, "pretty": null, "uri": "/contracts/dtO2GtHG9jE", "title": "PATIENT AGREEMENT", "group_id": "dtO2GtHG9jE", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/dtO2GtHG9jE", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/fbJy0WpqNYO", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "North Carolina", "type": "jurisdiction", "uri": "/contracts/tagged/north-carolina-us"}]}, {"intro": "This is an Agreement entered into on , 20 , between Vienna Primary andPreventative Medicine, a Virginia Professional Limited Liability Company (Practice, Us or We), and (Patient or You).", "id": "dyPCLmWZg1p", "source_url": "https://www.drjoffee.com/uploads/9/9/9/8/99989952/patient_agreement_with_2019_price_change.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "July 10th, 2019", "published": true, "pretty": null, "uri": "/contracts/dyPCLmWZg1p", "title": "PATIENT AGREEMENT", "group_id": "dyPCLmWZg1p", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/dyPCLmWZg1p", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/iCYm5ShSj6z", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}, {"name": "Virginia", "type": "jurisdiction", "uri": "/contracts/tagged/virginia-us"}]}, {"intro": "This Agreement is entered into by and between Impact Family Wellness (\u201cIFW\u201d), a Texas Professional Association, Monica McKitterick, APRN, Joanna Meley, APRN, & Jessica Katie Hamilton, APRN, FNP-C (\u201cproviders\u201d) and the undersigned patient (\u201cmember\u201d). IFW is a Direct Primary Care medical practice. The providers of IFW offer primary and urgent care services to the members of IFW. The providers deliver care on behalf of IFW at 507 Denali Pass, Suite 605, Cedar Park, TX. 78613 , and also provide care via electronic communication and phone. In exchange for the fees set out in this Agreement, the providers and IFW agree to provide the member the services set forth below. This agreement is entered by mutual voluntary consent.", "id": "f4nkCsUOQy1", "source_url": "https://s3-us-west-2.amazonaws.com/hint-api-production/document_versions/000/021/072/files/original.pdf?1633009871", "category_name": "Patient Agreement", "company_name": null, "created": "September 30th, 2021", "published": true, "pretty": null, "uri": "/contracts/f4nkCsUOQy1", "title": "Patient Agreement", "group_id": "f4nkCsUOQy1", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/f4nkCsUOQy1", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/gqZDF8FXCKr", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}]}, {"intro": "Most risks are related to the position of the nerves under the tissue, at the site of the injection, which cannot be determined prior to the administration of the anesthetic agent. Although the risks seldom occur they might include loss of sensation of the tongue and lip. If this occurs it is often temporary and normal sensation usually returns. However, in very rare cases the loss of sensation may extend for a longer period and may become permanent. In addition, injecting a foreign substance into the body such as an anesthetic agent may result in an allergic reaction. Allergic reactions to these agents are rare, but may take place.", "id": "gCyrsKTpm1O", "source_url": "http://www.allendaledental.com/pdfs/AllendaleDental_Patient_agreement-2024.pdf", "category_name": "Patient Agreement", "company_name": null, "created": "February 11th, 2013", "published": true, "pretty": null, "uri": "/contracts/gCyrsKTpm1O", "title": "PATIENT AGREEMENT & CONSENT FORM", "group_id": "gCyrsKTpm1O", "group_samples": [{"label": "Patient Agreement", "uri": "/contracts/gCyrsKTpm1O", "published": true}, {"label": "Patient Agreement", "uri": "/contracts/l35jmtiKZyN", "published": true}], "group_size": 2, "tags": [{"name": "Patient Agreement", "type": "category", "uri": "/contracts/tagged/patient-agreement"}]}, {"intro": "A thorough examination in all areas of your mouth will be done. This will include a detailed examination of the teeth, soft tissue, supporting structures, alignment, bite, TMJ, and oral cancer check. A complete set of x-rays will be taken if you have not had a complete set taken within the last 5 years. All of the information that we obtain will be carefully evaluated so that we may accurately assess your dental needs. A professional who is dedicated to you receiving maximum longevity from your natural dentition will clean your teeth. 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