$399.00 USD

An account already exists with this email address. Is this you?

Sign in
Yc5wesj8qwstz4omtd89 file

Patient Membership Agreement

Office Essential

What is it?

A contract that sets forth the agreement between the practice and the patient. It describes the scope of your services and sets out what is and what is not included in the membership (which you can customize for your needs).

Why do I need it?

It sets forth the division of liability; explains what is, and what is NOT, included in the membership services offered; and sets forth the rights and obligations of both the patient and provider.

When do I use it?

When a new patient becomes a patient member in your practice.

Who is this for?

All opted-out providers working within a cash-based membership model. This agreement is written specifically for providers who have opted-opt of insurance and Medicare, and who are not acting as a primary care provider.