Common Contracts
1 similar Financial Agreement contracts
Financial Agreement and Authorization FormFinancial Agreement • June 22nd, 2010
We thank you for choosing California Spine Diagnostics for your interventional pain services. The payment of your bill is an essential part of our financial relationship. In the course of your treatment, you may receive separate bills - the physician’s professional services, the facility, imaging services and tests, or laboratory tests. The following is a statement of our physician's financial agreement which we require you to read and sign before rendering services.
