Patient Intake

By my signature below, I acknowledge that I have read and understood each and every policy mentioned above in detail and I consent to abide by those policies.

I also acknowledge that the information provided above is true and correct. I also understand that any wrong information may render for refusal of this appointment application by TP-Health.

I also declare that I have signed this document voluntarily and of my own free will. I agree that any questions I may have, have been
answered.

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