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431 Pine Street Suite G01 Burlington, VT 05401 8024971002 movewell@movewellvt.com Patient Name: ___Date: ___Family Physician: ___ (Note: May we send your health information to this provider? Yes [Have
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Terms of acceptance are the conditions that must be agreed to in order to accept a certain offer or agreement.
The party receiving the offer or agreement is required to file the terms of acceptance.
Terms of acceptance can be filled out by reviewing the conditions of the offer and clearly stating acceptance or any requested modifications.
The purpose of terms of acceptance is to outline the agreed-upon conditions for accepting an offer or agreement.
Terms of acceptance must report the specific conditions agreed upon, any modifications requested, and the signature of the accepting party.
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