Common Contracts
2 similar Financial Policy Agreement contracts
BLOOMFIELD FOOT SPECIALISTS, LLC 1 NORTHWESTERN DRIVE, SUITE 301Financial Policy Agreement • September 7th, 2022
All co-pays and past due balances are due and payable at the time of service unless prior arrangements have been made. Your insurance company requires us to collect your co-pay at the time of your visit. It is not our policy to bill you for your co-pay; if not paid at the time of service a $10 fee will be assessed. Payment may be made with cash, check, Visa or MasterCard. We do not take Discover or American Express.
BLOOMFIELD FOOT SPECIALISTS, LLC 705 BLOOMFIELD AVENUE, SUITE 201Financial Policy Agreement • August 23rd, 2021
All co-pays and past due balances are due and payable at the time of service unless prior arrangements have been made. Your insurance company requires us to collect your co-pay at the time of your visit. It is not our policy to bill you for your co-pay; if not paid at the time of service a $10 fee will be assessed. Payment may be made with cash, check, Visa or MasterCard. We do not take Discover or American Express.
