Patient Intake Form

Any purchase, Utilization, or reliance upon, by You of the Resources of our Company (“Adopting Company”), including without limit our products, services, prices, discounts, financial terms, Websites, Software Applications, communications, enclosures / attachments, and Documents (\”Resources\”), shall indicate Your agreement to the most current Terms and Conditions of the Legal Notice and also Standards (collectively, “Terms”) located in the footer of our Website (“Structured Website Footer”) and accessible by means of hyperlinked menu options visibly located therein, below, and/or hereon as applicable. Previous versions of this Structured Website Footer are available at the following link. (Click here) Each Location listed on the Adopting Company’s Website(s) is an Independent Licensee of Adopting Company unless otherwise specified. Various \”Best Practice\” phrases (see, e.g., https://best-practices.us, https://system.best-practices.us, https://injury.best-practices.us) are trademarks of Proprietary Owner. All rights reserved. Standards include without limit the terms of our Supplemental Financial Policy.  *Any reference to prices, discounts and other financial terms include without limit “One-Time-Limited-Offer” terms located therein, is subject to medical necessity, and does not apply in the event you either elect or are required to have such item, along with any related course of care, submitted to an insurance payer (e.g., Medicare, Medicaid, etc.).  Additional limits apply.  For more info, refer to our Terms.