Client Financial Responsibility AgreementClient Financial Responsibility Agreement • March 2nd, 2018
We appreciate the confidence you have shown in choosing us to provide for your health care needs. The service you have elected to participate in implies a financial responsibility on your part. The responsibility obligates you to ensure payment of any charges not covered by your insurer, payment of any deductibles, co-pays and co-insurances as determined by your contract with your insurance carrier.
Client Financial Responsibility AgreementClient Financial Responsibility Agreement • August 12th, 2024
The following document explains The Wellness Centre’s payment policy and financial responsibility for all clients (including minors). It aims to minimize any misunderstanding about payment for services.
CASA Speech Therapy, LLC CLIENT FINANCIAL RESPONSIBILITY AGREEMENTClient Financial Responsibility Agreement • January 25th, 2019
Thank you for choosing CASA Speech Therapy, LLC (“CASA”) as your speech therapy and/or occupational therapy provider. This Agreement sets forth your financial obligations for all of the services your child receives from CASA Speech Therapy, LLC including the services provided today and in the future. If you do not understand any of the items discussed in this Agreement, we will explain those items to you.
