Common Contracts
2 similar Patient Financial Responsibility Agreement contracts
PATIENT FINANCIAL RESPONSIBILITY AGREEMENTPatient Financial Responsibility Agreement • July 13th, 2023
Please note that this agreement states your financial responsibility as a patient of Curtis Takemoto- Gentile, MD or Krishanna Takemoto-Gentile, MD “Dr. Curtis Takemoto-Gentile, MD Inc” and addresses the possibility of incurring out of pocket expenses.
PATIENT FINANCIAL RESPONSIBILITY AGREEMENTPatient Financial Responsibility Agreement • May 22nd, 2023
Please note that this agreement states your financial responsibility as a patient of Curtis Takemoto- Gentile, MD or Krishanna Takemoto-Gentile, MD “Dr. Curtis Takemoto-Gentile, MD Inc” and addresses the possibility of incurring out of pocket expenses.
