Common Contracts
2 similar Financial Agreement contracts
Financial AgreementFinancial Agreement • June 19th, 2019
The patient is expected to present an insurance card(s) at each visit. All co-payments and past due balances are due at time of check-in unless previous arrangements have been made with a billing coordinator. We accept cash, check or credit cards. Absolutely no post-dated checks will be accepted. Any co-pays requested to be billed to the patient, there will be a $10.00 fee added and will reflect on your statement.
Financial AgreementFinancial Agreement • June 19th, 2019
The patient is expected to present an insurance card(s) at each visit. All co-payments and past due balances are due at time of check-in unless previous arrangements have been made with a billing coordinator. We accept cash, check or credit cards. Absolutely no post-dated checks will be accepted. Any co-pays requested to be billed to the patient, there will be a $10.00 fee added and will reflect on your statement.
