Patient Conditions of Treatment and Informed Consent to Treat
This document is a binding agreement (the “Agreement”) between Denali Performance Clinic Services/Denali Performance Clinic and/or (We” “Us”) and the individual patient whose name and signature appears below (“You” “Your”). In consideration of the health care services provided to You by Us at the present and at all times in the future, You agree as follows (Your agreement indicated by checking the box in each section and by signing in the space provided):
I am either the patient or the patient's legally authorized representative consenting to the treatment on the patient's behalf. By signing below, I acknowledge that I have read through the above information, and confirm understanding and compliance.
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Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: Informed Consent
Agree & Sign