Common Contracts

3 similar Financial Agreement contracts

Financial Agreement
Financial Agreement • February 16th, 2017

I, understand that the Stram Center medical staff are non-participating with my current insurance plan carrier and therefore accept responsibility for payment of services at the time service is rendered. Furthermore, I understand that my current insurance plan will not be billed on my behalf for fees paid.

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Financial Agreement
Financial Agreement • August 3rd, 2016

I, understand that the Stram Center medical staff are non-participating with my current insurance plan carrier and therefore accept responsibility for payment of services at the time service is rendered. Furthermore, I understand that my current insurance plan will not be billed on my behalf for fees paid.

Financial Agreement
Financial Agreement • May 13th, 2016

I, understand that the Stram Center medical staff are non- participating with my current insurance plan carrier and therefore accept responsibility for payment of services at the time service is rendered. Furthermore, I understand that my current insurance plan will not be billed on my behalf for fees paid.

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