Common Contracts
4 similar Patient Financial Responsibility Agreement contracts
PATIENT FINANCIAL RESPONSIBILITY, ASSIGNMENT AND RELEASE AGREEMENTPatient Financial Responsibility Agreement • August 4th, 2021
Dental treatment is an excellent investment in you and your family’s health and wellbeing. We recognize that long range economy is of prime concern as well. The following rights and responsibilities are outlined below to aid in understanding our future dental relationship.
PATIENT FINANCIAL RESPONSIBILITY, ASSIGNMENT AND RELEASE AGREEMENTPatient Financial Responsibility Agreement • December 23rd, 2020
Dental treatment is an excellent investment in you and your family’s health and wellbeing. We recognize that long range economy is of prime concern as well. The following rights and responsibilities are outlined below to aid in understanding our future dental relationship.
PATIENT FINANCIAL RESPONSIBILITY, ASSIGNMENT AND RELEASE AGREEMENTPatient Financial Responsibility Agreement • March 14th, 2019
Dental treatment is an excellent investment in you and your family’s health and wellbeing. We recognize that long range economy is of prime concern as well. The following rights and responsibilities are outlined below to aid in understanding our future dental relationship.
PATIENT FINANCIAL RESPONSIBILITY, ASSIGNMENT AND RELEASE AGREEMENTPatient Financial Responsibility Agreement • March 4th, 2019
Dental treatment is an excellent investment in you and your family’s health and wellbeing. We recognize that long range economy is of prime concern as well. The following rights and responsibilities are outlined below to aid in understanding our future dental relationship.
