Common Contracts

1 similar Insurance and Payment Agreement contracts

Contract
Insurance and Payment Agreement • June 10th, 2022

!ank you for choosing Heart Rhythm Solutions (HRS) as your health care provider; we are committed to your treatment being successful! By signing below, you authorize your insurance company to release any information required to process claims and pay insurance benefits directly to HRS. Please review and sign this Insurance and Payment Agreement prior to services being rendered.

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