Common Contracts
3 similar Financial Agreement contracts
FINANCIAL AGREEMENTFinancial Agreement • May 18th, 2023
If the patient does have dental insurance, the responsible party will pay the ESTIMATED portion and deductable on the day of service. The insurance will be billed as a courtesy, however, please be aware if the insurance does not pay within 60 days payment in full is expected from the responsible party.
FINANCIAL AGREEMENTFinancial Agreement • February 1st, 2013
If the patient does not have dental insurance, payment in full is expected on the day of service. If the patient does have dental insurance, the responsible party will pay the ESTIMATED portion and deductable on the day of service. The insurance will be billed as a courtesy, however, please be aware if the insurance does not pay within 60 days payment in full is expected from the responsible party.
FINANCIAL AGREEMENTFinancial Agreement • August 4th, 2011
If the patient does have dental insurance, the responsible party will pay the ESTIMATED portion and deductable on the day of service. The insurance will be billed as a courtesy, however, please be aware if the insurance does not pay within 60 days payment in full is expected from the responsible party.
