NOTICE OF RIGHT TO RESCIND
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date rescission period begins
You may rescind and terminate your resident's agreement, without penalty or forfeiture, within 7 days of the above date. You are not required to move into the continuing care facility before the expiration of this 7 day period. No other agreement or statement you sign shall constitute a waiver of your right to rescind your agreement within the seven (7) day period.
To rescind your resident's agreement, mail or deliver a signed and dated copy of this notice, or any other dated written notice, letter or telegram, stating your desire to rescind to (name of provider/facility) at (business address) not later than midnight of (last day for rescission).
Pursuant to this notice, I hereby cancel my resident's agreement.
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Date
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PROSPECTIVE RESIDENT'S
SIGNATURE
31 Pa. Code § 151.9