Common Contracts
1 similar Client Financial Responsibility Agreement contracts
Client Financial Responsibility AgreementClient Financial Responsibility Agreement • August 18th, 2020
Thank you for choosing the Auburn Davis Center for DBT as your mental health care provider. We are honored by your choice and are committed to providing you with the highest quality healthcare. We ask that you read and sign this form to acknowledge your understanding of our client financial policies. The client (or client’s guardian if a minor) is ultimately responsible for the payment for his/her treatment and care. We are pleased to assist you by billing for providers that we have a relationship with, however, we are not an in-network provider for most insurance companies. Client’s are required to provide us with the most correct and updated information about their insurance and will be responsible for any charges incurred if information is not correct or updated.
