Common Contracts
1 similar Payment Authorization Agreement contracts
Payment Authorization AgreementPayment Authorization Agreement • April 7th, 2021
This Payment Authorization form will serve as the patient authorization and agreement for all providers within our Practice Management Group: Beyond Wellness LLC, Loudoun Family Chiropractic LLC, Dee Chiropractic PLLC, Natural Health Therapies LLC, Araya Holistic Pain Management LLC, Elite Performance Chiropractic and Wellness LLC and Core Health Chiropractic.
