Common Contracts
1 similar Service Agreement contracts
TIDWELL SOCIAL WORK SERVICES & CONSULTING, INC. SERVICE AGREEMENTService Agreement • May 5th, 2015
If yes, please read and sign the following statement: I request that payment of authorized insurance benefits be made to me or on my behalf to TSWSC for any services furnished me by that supplier. I authorized any holder of medical information about me to release to the Centers for Care Financing Administration and its agents any information needed to determine these benefits or the benefits payable for related services.
