Clinic Policies
CONSENT AND ACKNOWLEDGEMENT RECEIPT OF NOTICE OF PRIVACY PRACTICES
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FINANCIAL RESPONSIBILITY
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COVERAGE CHANGE
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EPISODES OF CARE
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WAITING ROOM PROCEDURES
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ATTENDANCE POLICY
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INFECTION CONTROL POLICY
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PHOTOGRAPHY/VIDEOGRAPHY POLICY
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Child name
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Parent/Guardian Name
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Parent/Guardian Email
example@example.com
Parent/Guardian Signature
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Submit
Should be Empty: