Get Siepser Laser Eyecare Co-management Agreement 2009-2025

This guide will assist users in completing the Siepser Laser Eyecare Co-Management Agreement online. It presents a clear, step-by-step approach to filling out the necessary fields of the agreement to ensure a smooth and efficient process.

Follow the steps to complete the agreement accurately.

1. Click ‘Get Form’ button to access the agreement and open it in the document editor.
2. Review the terms of the agreement carefully. Pay attention to the effective date and the notice required for termination of the agreement.
3. Fill in the section regarding referring patients. Provide details about the patients you will be managing postoperatively.
4. In the compensation section, input the details of the services you will be providing. Clearly state the agreed compensation rates for each type of surgery listed - cataract, Crystalens, and LASIK.
5. Complete the miscellaneous section. Ensure to provide information regarding your liability insurance and confirm your status as an independent contractor.
6. At the end of the document, clearly print or type your name and provide your signature in the designated spaces to indicate your acceptance of the terms.
7. After filling out all required fields, ensure to review the document for any errors. Save the changes, download a copy, or print it for your records before sharing it with Siepser Laser Eyecare.

Complete your Siepser Laser Eyecare Co-Management Agreement online today!