I hereby acknowledge I have received a copy of King Health Associates practice policies and have read completely, fully understood, and agree without limitation to abide by all policies listed in within this document.
I understand that I will not be able to access any services at King Health Associates without first agreeing to these policies and by signing and dating this form and returning it to office staff or my provider, electronically, by hand, or by mail, on or prior to, the date and time of my first appointment. This signed agreement will be added to my chart.
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