Office Hours Acknowledgement
Our Office Hours:
Monday - Friday from 7:30am to 6:00pm
Exceptions: Holidays
Acknowledgement
Owner Name
First Name
Last Name
Email
example@example.com
There are staff members present continuously during those times. At other times, including holidays, there is no in-house, on-duty continuous medical staff care. I have read this form and am aware of the above staffing hours.
Today's Date
-
Month
-
Day
Year
Date
Please verify that you are human
*
Submit
Should be Empty: