Common Contracts
1 similar Patient Responsibility Agreement contracts
PATIENT RESPONSIBILITY AGREEMENT/PAYMENT OPTIONSPatient Responsibility Agreement • July 18th, 2019
We will be happy to process your Insurance Claim Forms. While this is a courtesy we extend to our patients, ALL charges are the responsibility of the patient. We will do our best to ESTIMATE your portion of payment at the time of service; however, it is the patient’s responsibility to verify eligibility of their plan. The patient must pay any estimated portion AT THE TIME OF SERVICE.
