Common Contracts
1 similar Supplemental Financial Responsibility Agreement contracts
Supplemental Financial Responsibility AgreementSupplemental Financial Responsibility Agreement • April 11th, 2022
Custom Orthotics fitted and received from County Physical Therapy are a Cash & Carry product, and must be paid in full before receipt of the orthotics. The current price of Custom Orthotics is $300.00 for the initial pair, and $150.00 for each additional pair made from the same mold. This price includes the creation of a custom mold, the fabrication of the Custom Orthotic, and an initial fitting with any required modifications. A deposit of $150.00 is required prior to the orthotic molding process, with the balance due prior to receipt of the completed Custom Orthotic. Adjustments to the Custom Orthotic can be made by County Physical Therapy within the first 30 days after the initial fitting at no extra cost. After that time period, the patient will be charged for adjustments or modification of the Custom Orthotic at the rate of $15.00 for each 15 minutes of modification time required, with a minimum charge of $15.00.
