PATIENT MEMBERSHIP AGREEMENT FORWARD FAMILY HEALTHCARE, LLCPatient Membership Agreement • December 27th, 2022 • Nebraska
This Patient Membership Agreement (this “Agreement”) is entered into as of the date of its execution, as indicated below (the “Effective Date”), by and between Forward Family Healthcare, LLC, a Nebraska limited liability company (the “Clinic”), and (the “Patient”).
Patient Membership Agreement Action Medicine, DPC, PCPatient Membership Agreement • September 13th, 2017
This is an Agreement between you, the Member, and Action Medicine, DPC, PC, “Action Medicine” a Massachusetts professional corporation located at 175 N Franklin St, Holbrook, Massachusetts. Action Medicine is a Direct Primary Care medical practice owned and run by Dr. Michael W. Tremblay. In exchange for monthly fees paid by you, the Member, Action Medicine will provide the services described in this Agreement.
Patient Membership Agreement Medicare Beneficiary AddendumPatient Membership Agreement • September 10th, 2018
This agreement is between Dr. Erin Kershisnik or Dr. Jennifer Vazquez-Bryan ("Physician"), whose principal place of business is Vantage Physicians, 3703 Ensign Road Suite 10A, Olympia, WA 98506 and patient _________________________________________________ ("Patient"), who resides at _______________________________________________________ and is a Medicare Part B beneficiary seeking services covered under Medicare Part B pursuant to Section 4507 of the Balanced Budget Act of 1997.
HUMMINGBIRD HEALTH, LLC PATIENT MEMBERSHIP AGREEMENTPatient Membership Agreement • January 3rd, 2023 • Florida
This Membership Agreement is a contract for medical services to be provided by Hummingbird Health, LLC, and is effective as of the last date entered below.
Patient Membership AgreementPatient Membership Agreement • February 17th, 2022 • Georgia
This agreement is made effective on the date set forth on the signature page and is an agreement between, Erinn R. Harris MD, PC (“Harris Internal Medicine”) and the patient identified on the signature page (“you and/or member and/or patient”).
Patient Membership AgreementPatient Membership Agreement • May 31st, 2021
This is an Agreement between you, as a DaySpring Wellness “Member”, and our team here at DaySpring Integrative Wellness, SC, (“DaySpring”), as a professional Maine service corporation located at 1 North Street, Bath, Maine, 04530.
DIRECT PRIMARY CARE PATIENT MEMBERSHIP AGREEMENTPatient Membership Agreement • March 25th, 2021 • Indiana
This is an Agreement between Convenient Healthcare VA, LLC (Practice), a State of Virginia, Charlene Bell, FNP-C (Nurse Practitioner), in her capacity as an agent of Convenient Healthcare VA, LLC and you, (Patient).
PATIENT MEMBERSHIP AGREEMENT SPEAR DIRECT CARE, PLLCPatient Membership Agreement • April 28th, 2020 • Idaho
This is an Agreement entered into on , 20 , between Spear Direct Care, PLLC, an Idaho professional limited liability company (“Clinic”, “Us” or “We”), and
PATIENT MEMBERSHIP AGREEMENTPatient Membership Agreement • January 29th, 2024
Enlightened Family Medicine, LLC (“Practice”) and , (“Patient”) enter into this Direct Primary Care Membership Agreement (“Membership Agreement”) with the Effective Date as stated in Section 1(c) for Patient to become a member of Practice’s Direct Primary Care Program. Practice and Patient are referred to herein collectively as the “Parties.”
Patient Membership AgreementPatient Membership Agreement • June 22nd, 2018 • Georgia
This agreement is made effective on the date set forth on the signature page and is an agreement between, Erinn R. Harris MD, PC (“Harris Internal Medicine”) and the patient identified on the signature page (“you and/or member and/or patient”).
Patient Membership AgreementPatient Membership Agreement • March 1st, 2021 • Florida
• This agreement is made effective on the date set forth on the signature page and is an agreement between, St Johns Direct Primary Care, LLC (herein referred to as SJDPC) and the Patient identified on the signature page (“you and /or member and /or patient”).
Patient Membership AgreementPatient Membership Agreement • May 21st, 2015
This agreement is between Dr. Erin Kershisnik and or Dr. Samantha Ritchie ("Physician"), whose principal place of business is Vantage Physicians,
Patient Membership AgreementPatient Membership Agreement • October 11th, 2021 • Georgia
● This agreement is made effective on the date set forth on the signature page and is an agreement between, Harris Internal Medicine, LLC, and the patient identified on the signature page (“you and/or member and/or patient”).
