Common Contracts
1 similar Financial Agreement contracts
FINANCIAL AGREEMENTFinancial Agreement • December 16th, 2021
Agreement to Pay: By signing this document, I agree to pay Valley Cities Counseling & Consultation (hereunder referred to as “Agency”) all amounts due or to become due for services provided according to the terms of this agreement. I understand that I am financially responsible for any co-payments, co-insurance, deductible, or any charges not covered by my Third-Party Payor. I understand that all payments are due and payable at the time of service unless otherwise arranged with my service provider.
