Common Contracts
1 similar Fee Agreement contracts
FEE AGREEMENT AND FINANCIAL POLICYFee Agreement • June 18th, 2014
Please review this Fee Agreement and Financial Policy (the “Agreement and Policy”), which describes my schedule of fees for therapy services, charges not covered by insurance, and additional fees. Please be sure you understand the policies regarding cancelations and missed appointments, methods of payment, insurance reimbursement, and past due accounts. If you have any questions about anything, please ask me prior to signing this Agreement and Policy.
