Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 11 contracts
Samples: Financial Policy, Financial Policy, Financial Policy
Waiver of Confidentiality. You Please understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your you’re past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 2 contracts
Samples: Financial Office Policies, Financial and Office Policies
Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agencyagency or bureau, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Financial Agreement
Waiver of Confidentiality. You understand that if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office facility may become a matter of public record.
Appears in 1 contract
Samples: Financial Policy Agreement
Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, then the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Financial Policy
Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your you past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Financial Policy
Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agency, if we have to litigate lit- igate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Financial Agreement
Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your you’re past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Financial Policy
Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Financial Policy
Waiver of Confidentiality. You understand if this account is submitted to an attorney or collection agency, agency or if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Dental Financial Policy
Waiver of Confidentiality. You understand and agree that if this account is submitted to an attorney or a collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agencyagency or an attorney for litigation, the fact that you received treatment at our office may become a matter of public record.
Appears in 1 contract
Samples: Financial Policies Agreement