Common Contracts
1 similar Network Agreement contracts
FEE FOR SERVICE/OUT OF NETWORK AGREEMENTNetwork Agreement • July 5th, 2018
We/I enter into agreement to pay Potential Physical Therapy, LLC. for services rendered and acknowledge that I/we are solely responsible for financial reimbursement for our/my physical therapy sessions. We/ I agree to pay Potential $150.00 for the initial evaluation and $120.00 for each additional visit. *
