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Clinic Service Agreement
The Clinic Service Agreement defines the terms between a patient and healthcare provider, detailing services provided, patient responsibilities, consent for treatment, and liability release. This ensures clarity and protection for both parties during the healthcare process.
Healthcare & MedicalAgreement Forms, Consent Forms, Registration Forms
What is Clinic Service Agreement
The Clinic Service Agreement defines the terms between a patient and healthcare provider, detailing services provided, patient responsibilities, consent for treatment, and liability release. This ensures clarity and protection for both parties during the healthcare process.
Frequently Asked Questions
What is a Clinic Service Agreement waiver form?
A Clinic Service Agreement is a document that outlines the terms of care between a patient and a healthcare provider.
Why do I need a Clinic Service Agreement waiver form?
This agreement is necessary to clarify the responsibilities and rights of both the patient and provider, and to ensure mutual understanding and legal protection.
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 AgreementThis Clinic Service Agreement ("Agreement") is entered into by and between the patient ("Client") and the healthcare provider/clinic ("Provider"). This Agreement outlines the terms and conditions under which healthcare services will be provided.By signing below, the Client agrees to the terms set forth herein, acknowledging understanding and acceptance of the rights and responsibilities of both parties.
1. Services ProvidedThe Provider agrees to render healthcare and medical services as deemed necessary based on the Client's health assessment. These services may include diagnosis, treatment, follow-up care, and referral to specialists as appropriate.
2. Patient ResponsibilitiesThe Client agrees to provide accurate and complete medical history, follow prescribed treatment plans, keep scheduled appointments, and inform the Provider promptly of any changes in health status or concerns.
3. Consent for TreatmentThe Client voluntarily consents to the provision of medical services and procedures recommended by the Provider. The Client acknowledges that no guarantees have been made regarding the results of treatments.
4. ConfidentialityAll medical information provided by the Client will be kept confidential in accordance with applicable laws and regulations governing patient privacy.
5. Payment and FeesThe Client agrees to pay for services rendered according to the Provider's fee schedule. Payment is due at the time of service unless other arrangements have been made.
6. Release of LiabilityThe Client releases the Provider and its agents from any liability relating to the medical services provided, except in cases of gross negligence or willful misconduct.
7. TerminationEither party may terminate this Agreement with written notice. Termination will not affect the Client’s obligation to pay for services already provided.
8. Governing LawThis Agreement shall be governed by and construed in accordance with the laws of the applicable jurisdiction.
Full Name of Client
Client's Address
Client's Phone Number
Client's Email Address
Client's Age
I have read, understood, and agree to the terms of this Clinic Service Agreement.
Client's Signature
Healthcare Provider's Name
Healthcare Provider's Signature
I affirm that I am authorized to provide healthcare services and enter this Agreement on behalf of the Provider.
Date of Agreement
Please enter your email
We have sent you a registration email to . please follow the link in the email to complete your registration.