Teaching Clinic Fee Agreement Confirmation


1258 High Street, Eugene, OR 97401

Phone 541-342-8437 | Fax 541-242-2999

 Teaching Clinic Fee Agreement Confirmation

Full Name:   Date of birth:

I have reviewed the Teaching Clinic Fee Agreement completed by my therapist.


Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Teaching Clinic Fee Agreement Confirmation
lock iconUnique Document ID: 5a4a55f27be959fae047dd5fcca3388c7ec49e3f
Timestamp Audit
February 6, 2025 12:48 pm PDTTeaching Clinic Fee Agreement Confirmation Uploaded by Do Not Reply - donotreply@c-f-d.org IP 192.111.94.6
February 6, 2025 12:54 pm PDTCFD Main - Main@c-f-d.org added by Do Not Reply - donotreply@c-f-d.org as a CC'd Recipient Ip: 192.111.94.6