Billing and Payment Agreement Sample Contracts

BILLING AND PAYMENT
Billing and Payment Agreement • August 19th, 2019
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Billing and Payment Agreement
Billing and Payment Agreement • January 3rd, 2022
BILLING AND PAYMENT AGREEMENT
Billing and Payment Agreement • August 23rd, 2021

The purpose of this form is to provide you with information about your financial responsibilities and to establish an agreement regarding the payment for professional services that you receive from Dr. Leigh Hagglund.

Billing and Payment Agreement
Billing and Payment Agreement • March 16th, 2023
AGREEMENT REGARDING BILLING AND PAYMENT
Billing and Payment Agreement • July 17th, 2018

 Telephone calls, summary or referral letters pertaining to treatment, school and hospital visits, and outside consultation are billed at $120.00 per hour.

BILLING AND PAYMENT
Billing and Payment Agreement • December 12th, 2022
Billing and Payment Agreement
Billing and Payment Agreement • July 21st, 2017
Reference Access and Interconnection Offer
Billing and Payment Agreement • October 7th, 2018
BILLING AND PAYMENT AGREEMENT
Billing and Payment Agreement • July 26th, 2013

Welcome to Counseling Associates. We are happy that you have chosen us. Finances are always a sensitive subject to address, however, we believe that it is important to address insurance and payment issues at the onset of our relationship so that there are not issues on either one of our parts once the counseling process has begun. In order to facilitate a beneficial experience for you, let us explain how a counseling practice operates and provide some tips on how to utilize your insurance to your maximum advantage.

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