Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary documentation (i.e. your signature on the “Therapy Consent & Agreement” that covers the cancellation policy to your bank or credit card company should a dispute of a charge occur. If there is a financial balance on account, a bill will be sent to the home address on the intake form unless otherwise noted.
Appears in 8 contracts
Samples: Therapy Consent and Policies, Therapy Consent and Agreement, Therapy Consent and Policies Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. your signature on the “Therapy Consent & AgreementAgreements and Consent” that covers the cancellation policy to your bank Bank or credit card company Credit Card Company should a you dispute of a charge occurthat you are financially responsible for. If there is you have a financial balance on accountbalance, a bill you will be sent a xxxx to the home address on the intake form unless otherwise notedyou advise me otherwise.
Appears in 4 contracts
Samples: Therapy Agreement, Therapy Agreement, Therapy Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. your signature on the “Therapy Consent & AgreementAgreements and Consent” that covers the cancellation policy to your bank or credit card company should a you dispute of a charge occurfor which you are financially responsible. If there is you have a financial balance on accountbalance, a bill you will be sent a xxxx to the home address on the intake form unless otherwise notedyou advise me otherwise.
Appears in 2 contracts
Samples: Therapy Agreement, Therapy Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. your signature on the “Therapy Consent & AgreementAgreements and Consent” that covers the cancellation policy to your bank or credit card company should a you dispute of a charge occurthat you are financially responsible for. If there is you have a financial balance on accountbalance, a bill you will be sent a xxxx to the home address on the intake form unless otherwise notedyou advise me otherwise.
Appears in 2 contracts
Samples: Therapy Agreement, Therapy Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. your signature on the “Therapy Consent & AgreementAgreements and Consent” that covers the cancellation policy to your bank or credit card company Credit Card Company should a you dispute of a charge occurthat you are financially responsible for. If there is you have a financial balance on accountbalance, a bill you will be sent a bill to the home address on the intake form unless otherwise notedyou advise me otherwise.
Appears in 2 contracts
Samples: Therapy Agreement, Therapy Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. your signature on the “Therapy Consent & AgreementAgreements and Consent” that covers the cancellation policy to your bank or credit card company should a you dispute of a charge occurthat you are financially responsible for. If there is you have a financial balance on accountbalance, a bill you will be sent a bill to the home address on the intake form unless otherwise notedyou advise me otherwise.
Appears in 2 contracts
Samples: Therapy Agreement, Therapy Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. your signature on the “Therapy Consent & Agreement” Agreements and Consent”) that covers the cancellation policy to your bank Bank or credit card company Credit Card Company should a you dispute of a charge occurthat you are financially responsible for. If there is your account has a financial balance on accountbalance, a statement bill will be sent to the home address on the intake form form, unless otherwise notedwritten request is provided otherwise.
Appears in 1 contract
Samples: Therapy Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary documentation (i.e. i.e., your signature on the “Therapy Consent & Agreement” that covers the cancellation policy to your bank or credit card company should a dispute of a charge occur. If there is a financial balance on account, a bill will be sent to the home address on the intake form unless otherwise noted.
Appears in 1 contract
Samples: Therapy Consent and Policies
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. your signature on the “Therapy Consent & AgreementAgreements and Consent” that covers the cancellation policy to your bank Bank or credit card company Credit Card Company should a you dispute of a charge occurthat you are financially responsible for. If there is you have a financial balance on accountbalance, a bill you will be sent a bill to the home address on the intake form unless otherwise notedyou advise me otherwise.
Appears in 1 contract
Samples: Therapy Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary documentation (i.e. your signature on the “Therapy Consent & Agreement” that covers the cancellation policy to your bank or credit card company should a dispute of a charge occur. If there is a financial balance on account, a bill will be sent to the home address on the intake form unless otherwise noted.
Appears in 1 contract
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary documentation (i.e. your signature on the “Therapy Consent & Agreement” that covers the cancellation policy policy) to your bank or credit card company should a dispute of a charge occur. If there is a financial balance on your account, a bill will be sent to the home address on the intake form unless otherwise noted.
Appears in 1 contract
Samples: Therapy Consent Agreement
Fee Disputes. In the case of a credit card dispute, I reserve the right to provide the necessary needed and adequate documentation (i.e. i.e., your signature on the “Therapy Consent & AgreementAgreements and Consent” that covers the cancellation policy to your bank or credit card company Credit Card Company should a you dispute of a charge occurthat you are financially responsible for. If there is you have a financial balance on accountbalance, a bill you will be sent a bill to the home and/ or email address on the intake form unless otherwise notedyou advise me otherwise.
Appears in 1 contract
Samples: Therapy Agreement