Trading Terms

  1. Definitions
    1. The “Provider” shall mean the All On 4 Plus® Centre and all its companies, agents, associates, trading entities, its successors and assigns or any person acting on behalf of and with the authority of the Provider.
    2. “Patient” means the person/s purchasing the Treatments as specified in any invoice, document or order, and if there is more than one Patient is a reference to each Patient jointly and severally.
    3. “Treatments” shall mean all Treatments provided by the Provider to the Patient as described on the invoices, quotation (hereafter specified as “Treatment Plan”), or any other forms that are provided by the Provider to the Patient (and shall include the incidental supply of goods or services provided as part of the Treatments undertaken, or any advice or recommendations given by the Provider to the Patient), including variations to the Treatment Plan made during the course of Treatment.
    4. “Fees” shall mean the cost of the Treatments as agreed between the Provider and the Patient in accordance with clause 4 of this contract.
    5. “Debt” shall bear its natural meaning and refers to all Fees that remain unpaid and any fees and charges applicable under these Terms & Condtions of Trade, save and except when it is used within a payment agreement and/or direct debit request form/s (hereby collectively and individually referred to as the “Payment Agreement”), in which case “Debt” shall mean the total amount indicated within the Payment Agreement and may represent only a portion of the Fees and moneys owed by the Patient, and might exclude additional fees,charges and amounts that may be loaded under these Terms & Conditions of Trade.  Notwithstanding the use of the term Debt in any Payment Agreement/s, the Patient shall remain liable for the Fees and all moneys owed to the Provider  
    6. “Guarantor” shall mean a person, company or any other legal entity, which underwrites the Debt and guaranties the performance the Patient’s obligations under this contract.  Where the Guarantor is an entity other than a natural person, the director or shareholder (owning at least 15% of the shares) shall personally guarantee the performance of that entity and shall be personally liable for the performance of the Patient’s obligations under this contract.
    7. “Debtor” shall mean the Patient, or when not the Patient, a Guarantor who is responsible for the Patient’s Debt and who is liable for the performance of the Patient’s obligations under this contract.
    8. “Clinician” shall mean a doctor, dentist, dermal clinician, beauty therapist, or any the person nominated or employed by the Provider to administer the treatments. 


  1. Acceptance
    1. The Patient is taken to have exclusively accepted and is immediately bound, jointly and severally, by these terms and conditions if the Patient makes an appointment for, or accepts Treatments provided by the Provider
    2. These terms and conditions may only be amended with the Provider’s consent in writing and shall prevail to the extent of any inconsistency with any other document or agreement between the Patient and the Provider


  1. Change in Control
    1. The Patient shall give the Provider not less than fourteen (14) days prior written notice of any proposed change of in the Patient’s name, address, contact phone or any other change in the Patient’s details. The Patient shall be liable for any loss incurred by the Provider as a result of the Patient’s failure to comply with this clause.


  1. Fee and Payment
    1. At the Provider’s sole discretion the Fees shall be either:
      1. as indicated on invoices provided by the Provider to the Patient in respect of Treatments provided; or
      2. the Provider’s specified Fees as applicable to the individual Treatment Plan offered to and accepted by, or on the behalf of, the Patient. All Treatment Plan offers are only valid for thirty (30) Days from the date when they are first offered to the Patient and are subject to Fees review if the Patient wishes to accept a Treatment Plan after that period. 
    2. The Patient acknowledges and accepts that the Provider shall be entitled to vary the Fees where the Patient requests any change to the Treatments which are to be provided by the Provider, or where the Provider is required to revise the Fees due to circumstances beyond the reasonable control of the Provider
    3. The Patient acknowledges that the nature of medical, dental, surgical or aesthetic treatment is such that it must remain fluid and subject to the clinician’s findings during the course of administering the Treatments or components thereof.  The Patient accepts that there may be situations during the course of the Treatments that require modification to the Treatment Plan, and/or preclude the ability to complete or administer the Treatments within the planned or specified timeframe, and/or require the administration of additional treatment at additional fees, and consents to the use of discretion and variations as required based on the Clinician’s personal judgment exercised whilst administering the Treatments.
    4. At the Provider’s sole discretion, a non-refundable deposit may be required. 
    5. Time for payment for the Treatments being of the essence, the Fees will be payable by the Patient on, or in advance of, the date of the Treatments or components thereof, or in the alternative, and at the sole discretion of, and pre-approval by the Provider, on the date/s determined by the Provider, which may be:
      1. by way of instalments/progress payments in accordance with the Provider’s payment schedule;
      2. the date specified on any invoice or other form as being the date for payment; or
      3. failing any notice to the contrary, the date which is seven (7) days following the date of any invoice given to the Patient to the Provider 
    6. Payment may be made by cash, cheque, bank cheque, electronic/on-line banking, credit card, or by any other method as agreed to between the Patient and the Provider
    7. Unless otherwise stated the Fees does not include GST. In addition to the Fees the Patient must pay to the Provider an amount equal to any GST the Provider must pay for any provision of Treatments by the Provider under this or any other agreement. The Patient must pay GST, without deduction or set off of any other amounts, at the same time and on the same basis as the Patient pays the Fees. In addition the Patient must pay any other taxes and duties that may be applicable in addition to the Fees, except where they are expressly included in the Fees.
    8. Fees for any X-Ray services, including Cone Beam CT, and including situations where these services are provided free, at rebate or bulk billed, are only inclusive of the diagnosis by the Provider and do not include any re-prints, duplication or transfers. The Patient may request a print or digital copy subject to payment of a fee determined by the Provider  
    9. Any special offers published by the Provider from time to time are valid only on physical presentation of a printed copy of the special offer in advance of the provision of any Treatments to which the special offer may apply. the Provider will honour any offers or published fees at its sole discretion, and will advise the Patient accordingly in advance of administering the Treatments by way of a quote or Treatment Plan. Any special offers and discounts, whether promotional or discretionary, are non-cummulative and may not be combined with any other offers. Upon the Provider honouring a single special offer or applying a discount to the Treatments or components thereof, all other special offers become invalid. 
    10. the Provider does not guarantee the accuracy of fees or offers published on any of its websites.
    11. Free, rebate-only or bulk-billed services are to be deemed as though a discount had been applied to the typical fee for such service for the purpose of this agreement and shall be subject to clause 10.4(b).  A typical fee shall be equivallent to the greater of the fees shown in any recommended/average fee schedule published by Australian Dental Association, Australian Medical Association, Medicare, a health fund or any entity that conducts fee reasearch, or the average of Fees charged by the Provider to other clients for similar services in the preceeding three (3) months. 
    12. the Provider may offer price matching at its discretion. Price matching shall only apply to written quotes addressed to the Patient from similarly experienced providers who use the same materials and/or components, the same processes, and who work to the same quality standards, when the alternative quote is presented in advance of any Treatments or components thereof. It is the responsibility of the Patient to provide proof acceptable to the Provider in relation to any price matching.


  1. Provision of the Treatments
    1. the Provider may provide the Treatments by separate instalments. Each separate instalment shall be invoiced and paid for in accordance with the provisions in these terms and conditions.
    2. Any time specified by the Provider for provision of the Treatments is an estimate only and the Provider will not be liable for any loss or damage incurred by the Patient as a result of provision being late. However both parties agree that they shall make every endeavour to enable the Treatments to be provided at the time and place as was arranged between both parties. In the event that the Provider is unable to provide the Treatments as agreed solely due to any action or inaction of the Patient, then the Provider shall be entitled to charge the Patient additionally for re-providing the Treatments at a later time and date.


  1. Risk and Title
    1. The risk in all Treatments provided (including any goods supplied for the provision thereof) shall pass to the Patient immediately: 
      1. once the Treatment Plan is accepted by the Patient; and/or,
      2. upon the provision of the Treatments or components thereof; and/or
      3. upon the supply of any goods or services; and
      4. it shall be the Patient’s responsibility to ensure they are insured adequately or at all.
    2. the Provider and the Patient agree that the ownership of goods (whether supplied separately or as part of any Treatments) shall not pass until:
      1. the Patient has paid the Provider all amounts owing to the Provider; and
      2. the Patient has met all other obligations due by the Patient to the Provider in respect of all contracts between the Provider and the Patient.
    3. Receipt by the Provider of any form of payment other than cash shall not be deemed to be payment until that form of payment has been honoured, cleared or recognised and until then the Provider’s ownership or rights in respect of this the goods, and this agreement, shall continue.
    4. It is further agreed that, until ownership of the goods passes to the Patient in accordance with clause 6.2:
      1. that the Patient is only a bailee of the goods and must return the goods to the Provider on request. 
      2. the Patient should not convert or process the goods or intermix them with other products but if the Patient does so then the Patient holds the resulting product on trust for the benefit of the Provider and must sell, dispose of or return the resulting product to the Provider as it so directs. 
      3. the Patient irrevocably authorises the Provider to enter any premises where the Provider believes the goods are kept and recover possession of the goods.
      4. the Provider may commence proceedings to recover the Fee notwithstanding that ownership of the goods has not passed to the Patient.
    5. The Patient assumes all responsibility in relation to all risks, including medical risks, associated with the Patient ignoring the Provider’s recommendations or not proceeding with, or delaying, the execution and/or completion of the Treatment Plan or any components thereof by the Provider


  1. Personal Property Securities Act 2009 (“PPSA”)
    1. In this clause financing statement, financing change statement, security agreement, and security interest has the meaning given to it by the PPSA.
    2. Upon assenting to these terms and conditions in writing the Patient acknowledges and agrees that these terms and conditions constitute a security agreement for the purposes of the PPSA and creates a security interest in all goods and/or collateral (account) – being a monetary obligation of the Patient to the Provider for Treatments – that have previously been provided and that will be provided in the future by the Provider to the Patient.
    3. The Patient undertakes to:
      1. promptly sign any further documents and/or provide any further information (such information to be complete, accurate and up-to-date in all respects) which the Provider may reasonably require to;
        1. register a financing statement or financing change statement in relation to a security interest on the Personal Property Securities Register; 
        2. register any other document required to be registered by the PPSA; or
        3. correct a defect in a statement referred to in clause 7.3(a)(i) or 7.3(a)(ii);
      2. indemnify, and upon demand reimburse, the Provider for all expenses incurred in registering a financing statement or financing change statement on the Personal Property Securities Register established by the PPSA or releasing any registration made thereby;
      3. not register a financing change statement in respect of a security interest without the prior written consent of the Provider;
      4. not register, or permit to be registered, a financing statement or a financing change statement in relation to the goods and/or collateral (account) in favour of a third party without the prior written consent of the Provider
    4. the Provider and the Patient agree that sections 96, 115 and 125 of the PPSA do not apply to the security agreement created by these terms and conditions.
    5. The Patient waives their rights to receive notices under sections 95, 118, 121(4), 130, 132(3)(d) and 132(4) of the PPSA.
    6. The Patient waives their rights as a grantor and/or a debtor under sections 142 and 143 of the PPSA.
    7. Unless otherwise agreed to in writing by the Provider, the Patient waives their right to receive a verification statement in accordance with section 157 of the PPSA.
    8. The Patient must unconditionally ratify any actions taken by the Provider under clauses 7.3 to 7.5.
    9. Subject to any express provisions to the contrary nothing in these terms and conditions is intended to have the effect of contracting out of any of the provisions of the PPSA. 


  1. Security and Charge
    1. In consideration of the Provider agreeing to provide Treatments, the Patient charges all of its rights, title and interest (whether joint or several) in any land, realty or other assets capable of being charged, owned by the Patient either now or in the future, to secure the performance by the Patient of its obligations under these terms and conditions (including, but not limited to, the payment of any money). 
    2. The Patient indemnifies the Provider from and against all the Provider’s costs and disbursements including legal costs on a solicitor and own client basis incurred in exercising the Provider’s rights under this clause.
    3. The Patient irrevocably appoints the Provider and each director of the Provider as the Patient’s true and lawful attorney/s to perform all necessary acts to give effect to the provisions of this clause 8 including, but not limited to, signing any document on the Patient’s behalf.


  1. Defects, Warranties and the Competition and Consumer Act 2010 (CCA)
    1. The Patient must inspect the Treatments on completion and must within seven (7) days notify the Provider in writing of any evident defect in the Treatments provided (including the Seller’s workmanship) or of any other failure by the Provider to comply with the description of, or quote for, the Treatments which the Provider was to provide. The Patient must notify any other alleged defect in the Treatments as soon as is reasonably possible after any such defect becomes evident. Upon such notification the Patient must allow the Provider to review the Treatments that were provided.
    2. Under applicable State, Territory and Commonwealth Law (including, without limitation the CCA), certain statutory implied guarantees and warranties (including, without limitation the statutory guarantees under the CCA) may be implied into these terms and conditions (“Non-Excluded Guarantees”). 
    3. the Provider acknowledges that nothing in these terms and conditions purports to modify or exclude the Non-Excluded Guarantees. 
    4. Except as expressly set out in these terms and conditions or in respect of the Non-Excluded Guarantees, the Provider makes no warranties or other representations under these terms and conditions including, but not limited to, the quality or suitability of the Treatments. the Provider’s liability in respect of these warranties is limited to the fullest extent permitted by law. 
    5. If the Patient is a consumer within the meaning of the CCA, the Provider’s liability is limited to the extent permitted by section 64A of Schedule 2.
    6. If the Provider is required to rectify, re-provide, or pay the cost of re-providing the Treatments under this clause or the CCA, but is unable to do so, then the Provider may refund any money the Patient has paid for the Treatments, but only to the extent that such refund shall take into account the value of Treatments and goods which have been provided to the Patient which were not defective.
    7. If the Patient is not a consumer within the meaning of the CCA, the Provider’s liability for any defective Treatments is:
      1. limited to the value of any express warranty or warranty card provided to the Patient by the Provider at the Provider’s sole discretion;
      2. otherwise negated absolutely. 
    8. Notwithstanding clauses 9.1 to 9.7 but subject to the CCA, the Provider shall not be liable for any defect or damage which may be caused or partly caused by or arise as a result of:
      1. the Patient failing to properly maintain or store any Treatments; 
      2. the Patient using the Treatments or any goods for any purpose other than that for which they were designed, or outside the tolerances and/or limitations of the Treatments or goods; 
      3. the Patient continuing to use any goods after any defect became apparent or should have become apparent to a reasonably prudent individual; 
      4. interference with the Treatments by the Patient or any third party without the Provider’s prior approval;
      5. the Patient failing to follow any instructions or guidelines provided by the Provider;
      6. fair wear and tear, any accident, or act of God.
    9. The Patient accepts that the Treatments include dental, medical, aesthetic, cosmetic or surgical procedures and carry no guarantee as to the success of Treatments or components thereof, or that the Treatment will fulfil the Patient’s expectations.  
    10. A warranty may sometimes cover certain components of the Treatment, which are supplied by a third party and are subject to terms and conditions of any such third party, which may change from time to time. the Provider does not underwrite the performance of any stated or implied warranty in any way.




  1. Default and Consequences of Default
    1. Interest on overdue invoices shall accrue daily from the date when payment becomes due, until the date of payment, at a rate of two and a half percent (2.5%) per calendar month (and at the Provider’s sole discretion such interest shall compound monthly at such a rate) after as well as before any judgment.
    2. If the Patient owes the Provider any money the Patient shall indemnify the Provider from and against all costs and disbursements incurred by the Provider in recovering the debt (including but not limited to internal administration fees, legal costs on a solicitor and own client basis, the Provider’s contract default fee, and bank dishonour fees).
    3. Further to any other rights or remedies the Provider may have under this agreement, if a Patient has made payment to the Provider by credit card, and the transaction is subsequently reversed, the Patient shall be liable for the amount of the reversed transaction, in addition to any further costs incurred by the Provider under this clause 10 where it can be proven that such reversal is found to be illegal, fraudulent or in contravention to the Patient’s obligations under this agreement.
    4. Without prejudice to any other remedies the Provider may have, if at any time the Patient is in breach of any obligation (including those relating to payment) under these terms and conditions the Provider may:
      1. suspend or terminate the provision of Treatments to the Patient. the Provider will not be liable to the Patient for any loss or damage the Patient suffers because the Provider has exercised its rights under this clause;
      2.  revoke and reverse any discount that was given to the Patient, and the patient’s Debt shall increase by the amount of any such reversal.
    5. Without prejudice to the Provider’s other remedies at law the Provider shall be entitled to cancel all or any part of any order of the Patient which remains unfulfilled and all amounts owing to the Provider shall, whether or not due for payment, become immediately payable if:
      1. any money payable to the Provider becomes overdue, or in the Provider’s opinion the Patient will be unable to make a payment when it falls due; 
      2. the Patient becomes insolvent/bankrupt, convenes a meeting with its creditors or proposes or enters into an arrangement with creditors, or makes an assignment for the benefit of its creditors; or
      3. a receiver, manager, liquidator (provisional or otherwise) or similar person is appointed in respect of the Patient or any asset of the Patient.


  1. Cancellation
    1. the Provider may cancel any agreement to which these terms and conditions apply or cancel the provision of the Treatments at any time by giving notice to the Patient. On giving such notice the Provider shall repay to the Patient any sums already paid to the Provider in respect of the Fee, less any amount owing by the Patient to the Provider for Treatments already provided. the Provider shall not be liable for any loss or damage whatsoever arising from such cancellation.
    2. the Provider requires no less than forty-eight (48) hours’ notice that the Patient wishes to either cancel or reschedule an appointment (notice shall not be accepted if given on weekends or public holidays). Appointments cancelled with less than the required notice will (at the Provider’s sole discretion) incur a broken appointment fee equal to the FULL cost of the booked appointment, or $150 for each half hour segment allocated, whichever is the greater. 
    3. In the event that the Patient wishes to cancel the provision of Treatments after the Provider has already commenced provision thereof, then the Patient shall be liable to pay the Provider for all Treatments already provided (including any loss of profits).


  1. Federal Privacy Act 1988 and Victorian Health Records Act 2001
    1. The Patient agrees for the Provider to obtain from a credit reporting body (CRB) a credit report containing personal credit information (e.g. name, address, D.O.B, occupation, previous credit applications, credit history) about the Patient in relation to credit provided by the Provider 
    2. The Patient agrees that the Provider may exchange information about the Patient with those credit providers and with related body corporates for the following purposes:
      1. to assess an application by the Patient; and/or
      2. to notify other credit providers of a default by the Patient; and/or
      3. to exchange information with other credit providers as to the status of this credit account, where the Patient is in default with other credit providers; and/or
      4. to assess the creditworthiness of the Patient including the Patient’s repayment history in the preceding two years.
    3. The Patient consents to the Provider being given a consumer credit report to collect overdue payment on commercial credit.
    4. The Patient agrees that personal credit information provided may be used and retained by the Provider for the following purposes (and for other agreed purposes or required by):
      1. the provision of Treatments; and/or
      2. analysing, verifying and/or checking the Patient’s credit, payment and/or status in relation to the provision of Treatments; and/or
      3. processing of any payment instructions, direct debit facilities and/or credit facilities requested by the Patient; and/or
      4. enabling the collection of amounts outstanding in relation to the Treatments.
    5. the Provider may give information about the Patient to a CRB for the following purposes:
      1. to obtain a consumer credit report; 
      2. allow the CRB to create or maintain a credit information file about the Patient including credit history.
    6. The information given to the CRB may include:
      1. personal information as outlined in 12.1 above;
      2. name of the credit provider and that the Provider is a current credit provider to the Patient;
      3. whether the credit provider is a licensee;
      4. type of consumer credit;
      5. details concerning the Patient’s application for credit or commercial credit (e.g. date of commencement/termination of the credit account and the amount requested);
      6. advice of consumer credit defaults, overdue accounts, loan repayments or  outstanding monies which are overdue by more than sixty (60) days and for which written notice for request of payment has been made and debt recovery action commenced or alternatively that the Patient no longer has any overdue accounts and the Provider has been paid or otherwise discharged and all details surrounding that discharge(e.g. dates of payments);
      7. information that, in the opinion of the Provider, the Patient has committed a serious credit infringement;
      8. advice that the amount of the Patient’s overdue payment is equal to or more than one hundred and fifty dollars ($150).
    7. The Patient shall have the right to request (by e-mail) from the Provider:
      1. a copy of the information about the Patient retained by the Provider and the right to request that the Provider correct any incorrect information; and
      2. that the Provider does not disclose any personal information about the Patient for the purpose of direct marketing. The patient agrees to reimburse the Provider in advance a sum reasonably determined by FACALAB for its expenses, remarketing costs and losses associated with removing or editing any photographs, videos or marketing material for which the patient provided a prior non-cancellable consent or agreement. The patient also agrees to the reversal of any discounts and payment of the full fees for any treatment received in lieu of photographs, videos or material obtained from the Patient for the purpose of marketing.
    8. the Provider will destroy personal information upon the Patient’s request (by e-mail) or if it is no longer required unless it is required in order to fulfil the obligations of this agreement or is required to be maintained and/or stored in accordance with the law. 
    9. The Patient can make a privacy complaint by contacting the Provider via e-mail. the Provider will respond to that complaint within seven (7) days of receipt and will take all reasonable steps to make a decision as to the complaint within thirty (30) days of receipt of the complaint. In the event that the Patient is not satisfied with the resolution provided, the Patient can make a complaint to the Information Commissioner at www.oaic.gov.au.
    10. the Provider has adopted a Privacy Policy and follows these procedures:
      1. The information collected from the Patient will be used for the purpose of providing treatment.  Personal information such as Patient’s name, address and health insurance details will be used for the purpose of addressing accounts to the Patient, as well as processing payments and writing to the Patient about the Provider’s services and any issues affecting the Patient or treatment.
      2. the Provider may disclose the Patient’s health information to other health care professionals, or require it from them if, in the Provider’s judgement, that is necessary in the context of the Patient’s treatment.  In that event, disclosure of the Patient’s personal details will be minimised wherever possible.
      3. the Provider may also use parts of the Patient’s health information and records for research purposes, in study groups or at seminars as this may provide benefit to other patients or professional colleagues.  Should that happen, the Patient’s personal identity will not be disclosed without consent to do so.
      4. The Patient’s medical history, treatment records, x-rays and any other material relevant to the Patient’s treatment will be kept at the Provider for a period of four (4) years, and will be archived off site for a further period as required by law.  The Patient may inspect or request copies of the records of treatment at any time, or seek an explanation from the Provider.  Statutory fees will apply in relation to the types of access the Patient seeks.  If the Patient requests an explanation of the Provider’s records or a written summary, the Provider’s usual or hourly fees (whichever the greater) apply to these services.
      5. If any of the information the Provider has about the Patient is inaccurate, the Patient may ask the Provider to alter the records accordingly. 
      6. The Treatment Plan will often be posted to the Patient’s referring doctor or dentist, or another person involved (or was involved) in the Patient’s overall care, as may be appropriate or required.   The Patient must notify the Provider in writing if they have any objections.
    11. The Patient’s health information will be treated with the utmost confidentiality.  Disclosure will not be made to any person not involved in either the Patient’s treatment or the administration of the Provider and the practice; or any person who is NOT a participant of a training and/or education program, or seminar without the Patient’s prior consent.  


  1. General
    1. The failure by the Provider to enforce any provision of these terms and conditions shall not be treated as a waiver of that provision, nor shall it affect the Provider’s right to subsequently enforce that provision. If any provision of these terms and conditions shall be invalid, void, illegal or unenforceable the validity, existence, legality and enforceability of the remaining provisions shall not be affected, prejudiced or impaired.
    2. These terms and conditions and any contract to which they apply shall be governed by the laws of Victoria, the state in which the Provider has its principal place of business, and are subject to the jurisdiction of the Melbourne Courts in that state.  
    3. Subject to clause 9, the Provider shall be under no liability whatsoever to the Patient for any indirect and/or consequential loss and/or expense (including loss of profit) suffered by the Patient arising out of a breach by the Provider of these terms and conditions (alternatively the Provider’s liability shall be limited to damages which under no circumstances shall exceed the Fee).
    4. The Patient shall not be entitled to set off against, or deduct from the Fee, any sums owed or claimed to be owed to the Patient by the Provider nor to withhold payment of any invoice because part of that invoice is in dispute.
    5. the Provider may license or sub-contract all or any part of its rights and obligations without the Patient’s consent.
    6. The Patient agrees that the Provider may amend these terms and conditions at any time. If the Provider makes a change to these terms and conditions, then that change will take effect from the date on which the Provider notifies the Patient of such change. The Patient will be taken to have accepted such changes if the Patient makes a further request for the Provider to provide Treatments to the Patient. 
    7. Neither party shall be liable for any default due to any act of God, war, terrorism, strike, lock-out, industrial action, fire, flood, storm or other event beyond the reasonable control of either party.
    8. The Patient warrants that it has the power to enter into this agreement and has obtained all necessary authorisations to allow it to do so, it is not insolvent and that this agreement creates binding and valid legal obligations on it.
    9. Save and except any omissions under clause 13.1, no part of this agreement may be crossed out or omitted by the Patient without the signed consent of the Provider
As seen in
Logo
Logo
Logo
Logo
Logo
Logo