Common Contracts
1 similar Patient Financial Agreement contracts
Patient Financial AgreementPatient Financial Agreement • April 26th, 2023
Co-payments are due at the time of service. If you are unable to remit your co-payment amount, the office reserves the right to reschedule your appointment for another day/time that is convenient for you. If you wish to be seen at your regularly scheduled appointment the practice reserves the right to bill an additional $20.00 fee if the copay is not remitted by the end of the business day.
