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ORDER
ONLINE NOW!
View
Form Online
Acrobat©
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required to view. (See Note
below.)
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ACKNOWLEDGEMENT
&
CONSENT
Forms
Customized
for YOUR Practice:
|
·
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Quick
& Convenient – Patients just sign,
date, and print full name – nothing for your staff or patients to
fill out. |
|
|
|
·
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Full Customization
– From basic name and address imprinting
to adding your logo or letterhead, we can do it all. Maximize
your HIPAA compliance by including modifications and amendments to the
Patient's Rights terms listed in the Patient Education Kit educational
pamphlets. |
|
|
|
·
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Drilling and
Padding Included – Easily stored in your
front desk area and ready to be inserted into patient charts. |
|
|
|
·
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FREE
SHIPPING! |
|
| Prices |
Retail
|
Medical
Society
10%
Member
|
| Acknowledgement & Consent |
Price
|
Discount
|
| 500 forms, with custom imprinting |
$89.95
|
$80.96
|
| 1,000 forms, with custom imprinting |
$144.95
|
$130.46
|
| 2,500 forms, with custom imprinting |
$249.95
|
$224.96
|
| 5,000 forms, with custom imprinting |
$369.95
|
$332.96
|
| 10,000 forms, with custom imprinting |
$664.95
|
$598.46
|
| Padding and 2-hole drilling |
FREE
|
FREE
|
| |
|
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| Imprint Setup Cost |
|
|
| Standard (Name/Address,
type only) |
$24.95
|
$22.45
|
| Custom (w/
logo/letterhead, new terms, etc.) |
$49.95
|
$44.96
|
Order
ONLINE
– it's fast and easy.
Or
call 301-527-8897
to
order by phone or fax.
Operators
are available to assist you from 9:00 AM to 6:00 PM EST/EDT.
Fax
ordering and detailed information via Fax-on-Demand available continuously.
Click the logo to get Acrobat©
Reader©.
Note:
The PDF files on this web site have been password encrypted to allow viewing
and printing only. The samples posted on this page are the property of
Scriptoria LLC, and may not be copied, modified, printed, posted to other
Internet locations or used for any purpose other than those expressly stated
herein. Users of this online service are granted limited perusal rights
solely for information gathering purposes.
All other uses are
prohibited without the permission of Scriptoria LLC. |
MDforms.com
is
a service of:
Scriptoria
LLC ·
38 Cinnabar Court ·
Gaithersburg, MD 20879-4570
301.527.1645
·
301.527.8758 (fax)
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