Patient Consent and Authorization Agreement Sample Contracts

Patient Number: Understanding and Agreement of:
Patient Consent and Authorization Agreement • February 12th, 2019
Contract Type
Filed
February 12th, 2019
• I consent to the necessary treatment for the above named patient and acknowledge receipt of the Notice of Privacy Practices.

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POLICY AGREEMENT
Patient Consent and Authorization Agreement • September 10th, 2024
Contract Type
Filed
September 10th, 2024
Thank you for choosing Liberty Doctors (LD) DBA Tiffany Pediatrics to meet your medical needs. We are dedicated to providing the best treatment available. Carefully read and please sign and date the bottom.