Common Contracts
1 similar Financial Agreement contracts
FINANCIAL AGREEMENTFinancial Agreement • January 3rd, 2022
In agreement with the services that will be provided by Richmond Creative Counseling (RCC), I hereby agree and authorize my insurance company to pay this practice in full for services rendered in accordance with my medical benefits as agreed to in my insurance policy. I hereby authorize RCC to release to my insurance company any information necessary for seeking reimbursement for the services listed below.
