Common Contracts
1 similar Patient Registration / Financial Agreement contracts
PATIENT REGISTRATION / FINANCIAL AGREEMENTPatient Registration / Financial Agreement • February 12th, 2020
Thank you for taking time to complete this form. This information is necessary for the preparation of your clinic records. You are responsible for all charges as billed. PLEASE INFORM RECEPTIONIST IF VISIT IS WORKER’S COMP OR AUTO ACCIDENT RELATED.
