Common Contracts
1 similar Client Agreement contracts
Client AgreementClient Agreement • February 13th, 2018
Insurance: I authorize Nutrition Therapy and Wellness to release information to my insurance companies and to be paid directly by my insurance companies for services billed. I understand that it is my responsibility to know what my insurance plan covers, whether or not a referral or pre-authorization is required and if there are any limitations of coverage (number of allowed visits, covered diagnoses, etc). If claims are denied for any reason, I acknowledge that I am responsible for the full amount billed to insurance and the below credit card will be used with a superbill and receipt emailed to the below address.
