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Clinic Agreement
The Clinic Agreement outlines the terms between the Client and the Clinic for healthcare services. It covers responsibilities, risks, confidentiality, and payment details. Clients must acknowledge and agree to these terms to receive services.
Healthcare & MedicalAgreement Forms, Consent Forms, Registration Forms
What is Clinic Agreement
The Clinic Agreement outlines the terms between the Client and the Clinic for healthcare services. It covers responsibilities, risks, confidentiality, and payment details. Clients must acknowledge and agree to these terms to receive services.
Frequently Asked Questions
What is a Clinic Agreement waiver form?
A Clinic Agreement waiver form is a document that outlines the terms and conditions for healthcare services between a client and a healthcare provider.
Why do I need a Clinic Agreement waiver form?
This waiver form is needed to ensure clarity on responsibilities, risks, and confidentiality, allowing the clinic to operate safely and efficiently.
How can I customize this waiver template for my business?
Customizing this waiver template is quick and simple through our user-friendly editor. You can edit any text content, add or remove clauses, insert your business logo, add custom fields to collect specific information, include additional signature fields, and modify the layout to match your business needs. All changes are automatically saved to your account for immediate use.
Is this undefined waiver template free to use?
Yes, all our waiver templates are free to use for all WaiverForever users . WaiverForever gives you full access to our complete template library with unlimited customization options, secure digital storage, electronic signature capabilities, mobile app access, and customer management features. We also offer a generous free plan to help businesses get started, allowing you to explore our platform and templates before committing to a paid subscription.
Clinic Service Agreement and Liability WaiverThis Clinic Agreement ("Agreement") is entered into between the client ("Client") and the healthcare provider ("Clinic"). This Agreement outlines the terms and conditions under which the Clinic agrees to provide healthcare services to the Client and the obligations of the Client when receiving such services. Please read carefully before signing.By signing this Agreement, the Client acknowledges and agrees to the following terms:
Full Name of Client
Date of Birth
Address
Contact Phone Number
Email Address
1. Services: The Clinic agrees to provide healthcare services as described in the specific program, treatment plan, or consultation agreed upon by both parties. Services may include but are not limited to medical assessments, treatments, evaluations, and follow-up care.
2. No Guarantee of Results: The Client understands and acknowledges that medical and health-related services may vary in outcomes, and no guarantee is made regarding the effectiveness or results of any treatment or service.
3. Client Responsibility: The Client agrees to provide accurate and complete information about their medical history, current condition, and medications. The Client will follow the Clinic’s instructions and notify the Clinic immediately of any changes in their condition or adverse reactions.
4. Confidentiality: Both parties agree that all personal and medical information disclosed during the course of service shall be kept confidential in accordance with applicable laws and regulations.
5. Assumption of Risk and Release of Liability: The Client voluntarily assumes all risks related to receiving healthcare services, including potential adverse effects. The Client releases the Clinic, its employees, agents, and contractors from any liability relating to injury, loss, or damage resulting from services provided, except in cases of gross negligence or willful misconduct.
6. Payment and Fees: The Client agrees to pay all fees associated with services provided as outlined in the fee schedule. Payments are due as specified and may be subject to additional charges for late or missed appointments.
7. Termination of Services: Either party may terminate this Agreement at any time with appropriate notice. The Clinic reserves the right to discontinue services if the Client does not comply with treatment plans, payment obligations, or behaves inappropriately.
8. Governing Law: This Agreement shall be governed and construed in accordance with the laws of the jurisdiction in which the Clinic operates.
I confirm that I have read, understood, and agree to all terms and conditions stated in this Clinic Agreement and liability waiver.
Client Signature
Date of Signature
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