Get the free BeWise Clinic Provider Agreement

Utah State Department of Health BUREAU OF HEALTH PROMOTION P.O. Box 142107 Salt Lake City, Utah 84114-2107 Telephone: (801) 538-6712 or 1-800-717-1811 Fax: (801) 538-9495 CCP Be Wise CLINIC PROVIDER

How to fill out bewise clinic provider agreement

To fill out the BeWise Clinic provider agreement, follow these steps:

1. Obtain a copy of the agreement from the BeWise Clinic. This can usually be found on their website or requested directly from their administrative office.
2. Carefully read through the entire agreement to familiarize yourself with the terms and conditions. Pay attention to specific requirements or obligations that are outlined.
3. Gather any necessary information or documentation that may be required to complete the agreement. This may include personal and professional information, proof of licensure or certification, and insurance details.
4. Fill in the required fields of the agreement. This may include your name, contact information, professional credentials, services to be provided, and any other relevant details.
5. Review the completed agreement to ensure accuracy and completeness. Double-check that all information provided is truthful and up-to-date.
6. If there are any sections or clauses that you are unsure of or have questions about, reach out to the BeWise Clinic for clarification. It is essential to have a clear understanding of the agreement you are entering into.
7. Sign and date the agreement in the appropriate spaces provided. By signing, you acknowledge that you have read and agreed to the terms and conditions outlined in the provider agreement.
8. Keep a copy of the signed agreement for your records. This will serve as proof of your agreement with the BeWise Clinic.

Anyone who wishes to provide services at the BeWise Clinic needs to have a signed provider agreement. This includes healthcare professionals, therapists, counselors, or any individual or entity involved in delivering services to patients or clients at the clinic. The provider agreement ensures accountability and sets out the expectations and responsibilities of the provider in relation to the clinic.

For pdfFiller’s FAQs

What is bewise clinic provider agreement?

The Bewise Clinic provider agreement is a contract between Bewise Clinic and healthcare providers outlining the terms of their relationship and services provided.

Who is required to file bewise clinic provider agreement?

All healthcare providers working with Bewise Clinic are required to file the provider agreement.

How to fill out bewise clinic provider agreement?

The Bewise Clinic provider agreement can be filled out by completing the necessary fields with accurate information regarding the provider and services.

What is the purpose of bewise clinic provider agreement?

The purpose of the Bewise Clinic provider agreement is to establish a formal relationship between Bewise Clinic and healthcare providers, outlining expectations and responsibilities.

What information must be reported on bewise clinic provider agreement?

The provider agreement must include details such as provider's contact information, services provided, payment terms, and any other relevant terms and conditions.

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