Common Contracts
1 similar Treatment Cost and Payment Agreement contracts
ContractTreatment Cost and Payment Agreement • October 3rd, 2023
AGREEMENT FOR UNDERSTANDING OF TREATMENT COSTS AND PAYMENT RESPONSIBILITIES This Agreement ("Agreement") is entered into between Simpladent Clinics, located at Radisson Blue, Kaushambi, Delhi NCR, India , herein referred to as the "Clinic," and the patient, herein referred to as the "Patient," who is seeking dental treatment at the Clinic. 1. Treatment Cost Estimate 1.1. The Clinic has provided the Patient with an estimate of the total cost of the dental treatment, which includes all applicable fees, such as professional fees, laboratory fees, materials, and any other associated costs. 1.2. The Patient acknowledges and agrees that this estimate is based on the initial assessment and treatment plan and may be subject to change if additional procedures or services become necessary. 2. Payment Responsibilities 2.1. The Patient agrees to be responsible for the full payment of all dental treatment costs incurred during their visit to the Clinic. 2.2. Payment can be made through t
