Common Contracts
1 similar Patient Financial Policy contracts
Hoosier Foot and Ankle Financial Policy Please read below and initial on line next to each policy and sign agreement. Patient Financial PolicyPatient Financial Policy • August 15th, 2019
____ You must complete a New Patient Registration form providing all personal information required and complete any insurance information as required on the form. This information must be provided to the office at least 2 days prior to your appointment for verification of medical insurance. In the event the office is not provided with this information, you will be responsible for all charges not covered by your insurance. Hoosier Foot and Ankle will attempt to verify insurance benefits and eligibility prior to your visit; however, these verifications are NOT a guarantee of payment.
