Independent Contractor and Indemnity Agreement-Dentist

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					                            Independent contractor and indemnity agreement—Dentist.

                                   Independent Contractor and Indemnity Agreement

    This independent contractor and indemnity agreement ("Agreement") is executed as of [Date], between       ,a
(state) professional corporation (the "Company") through its President, and     (the "Dentist") [insert name and
address here].

    The Dentist expressly represents and warrants to the Company that (i) he or she is not and shall not be construed to
be an employee of the Company and that his or her status shall be that of an independent contractor for which he or she
is solely responsible for his or her actions and inactions and for filing all necessary forms and returns and for making all
required payments with the relevant taxing authorities; (ii) the Dentist acknowledges that he or she is and will be acting
independent of any direction and supervision by the Company or any of its officers and agents and that his or her
compensation will arise from and be determined solely by and through his or her acts and efforts; and (iii) he or she has
obtained and has in effect professional liability insurance in amounts reasonably necessary to cover actions and/or
injuries which may be foreseeable in light of the service which the Dentist performs on the premises of the Company.

     Further, the Dentist agrees to indemnify and hold the Company harmless, to the fullest extent permitted by law, and
its officers, agents and employees from and against all claims, damages, losses and expenses, including but not limited
to attorney's fees and expenses, arising out of or resulting from (i) the action or inaction of the Dentist attributable to
bodily injury, sickness, disease, or death, or to other injury or illness including the loss of any income resulting from it,
to the extent caused in whole or in part by any negligent act or omission of the Dentist or anyone directly employed by
him or her or anyone for whose acts he or she may be liable; or (ii) any breach of the representations or warranties
contained here. Such obligation shall not be construed to negate, or abridge, or otherwise reduce any other right or
obligation of indemnity which would otherwise exist in favor of the Company against the Dentist.

   The obligations of the Dentist under this Agreement shall not be affected by any actions or inactions of the
Company or its agents or employees including but not limited to (1) the leasing of facilities to the Dentist or making
available facilities and equipment for which the Dentist may practice dentistry, or (2) the giving of or the failure to give
advice, directions or instructions.

   This Agreement has been executed and delivered as of the date first written above.

Accepted and Agreed [Date]]

                                                                                                       Signature of Dentist


                                                                                                               electronic form 2005
                                                                                                               Law Publishers