Common use of Notice to the Undersigned Clause in Contracts

Notice to the Undersigned. Do not sign this document before you read it. This agreement is effective as of the date of my signature and applies to all services provided during the patient’s current course of treatment. If the undersigned is not the patient, the undersigned represent and warrant that they have full legal authority to sign this Agreement on behalf of the patient. I have read and fully understand this Agreement. I acknowledge receipt of a copy of this Agreement. Patient or Legal Representative Name: Date:

Notice to the Undersigned. Do not sign this document before you read it. This agreement is effective as of the date of my signature and applies to all services provided during the patient’s current course of treatment. If the undersigned is not the patient, the undersigned represent and warrant that they have full legal authority to sign this Agreement on behalf of the patient. I have read and fully understand this Agreement. I acknowledge receipt of a copy of this Agreement. Patient or Legal Representative NameName : Date: