This visit is for a one-time or limited service only. It does not establish an ongoing primary care relationship with this clinic or provider. I am responsible for follow-up on test results and urgent care needs after today’s visit. Any chronic condition management, preventive care, or follow-up must be scheduled separately.
If symptoms worsen or new concerns arise after this visit, I understand that I am responsible for seeking follow-up care with my primary care provider or emergency services as appropriate.
