Common Contracts
1 similar Patient Financial Responsibility Agreement contracts
Ph: 214-216-6564 Fax: 214-385-2574 Patient Financial Responsibility AgreementPatient Financial Responsibility Agreement • June 17th, 2023
I, ______________________________________________________, understand and agree to the following financial responsibilities associated with the medical services provided by Texas Gastroenterology Center PLLC (Dr Muhammad Osman Arif) and/or Texas Arthritis and Rheumatology PLLC (Dr Zainab Shahnawaz).
