Common Contracts
2 similar Client Financial Responsibility Agreement contracts
Client Financial Responsibility AgreementClient Financial Responsibility Agreement • March 2nd, 2018
We appreciate the confidence you have shown in choosing us to provide for your health care needs. The service you have elected to participate in implies a financial responsibility on your part. The responsibility obligates you to ensure payment of any charges not covered by your insurer, payment of any deductibles, co-pays and co-insurances as determined by your contract with your insurance carrier.
Client Financial Responsibility AgreementClient Financial Responsibility Agreement • March 1st, 2018
We appreciate the confidence you have shown in choosing us to provide for your health care needs. The service you have elected to participate in implies a financial responsibility on your part. The responsibility obligates you to ensure payment of any charges not covered by your insurer, payment of any deductibles, co-pays and co-insurances as determined by your contract with your insurance carrier.
