ContractClient Payment Agreement • July 6th, 2022
This payment does NOT include extra charges that may be incurred for items including, but not limited, overages, late payment fees, field trips, and registration, as agreed upon in advance. Rising Sun must retain a copy of each current written payment agreement at the location where child care is provided. Rising Sun must retain a copy of an expired written payment agreement for 3 years after the agreement is terminated and the child no longer attends. The expired agreement may be kept at a location where it can be made available to the Department of Children and Families within 24 hours.
Client Payment AgreementClient Payment Agreement • April 2nd, 2016
JNG Health Network seeks to provide quality therapeutic services to children, adolescents, adults, and older adults at an affordable cost. All clinical interventions, including psychological evaluations are provided according to clients’ therapeutic needs. JNG Health Network has designed a sliding fee scale, which takes into consideration family size, to assist clients whose income brackets meet criteria for income-sensitive accommodation. On a case-by-case basis, JNG Health Network also encourages and supports the rendering of pro-bono services. The fee scale below is an outline of the therapeutic services offered and their estimated costs.
Client Payment AgreementClient Payment Agreement • March 14th, 2021
JNG Health Network provide quality therapeutic services to children, adolescents, adults, and older adults at an affordable cost. All clinical interventions, including psychological evaluations are provided according to clients’ therapeutic needs. JNG Health Network has designed a sliding fee scale, which takes into consideration family size, to assist clients whose income brackets meet criteria for income-sensitive accommodation. On a case-by-case basis, JNG Health Network also encourages and supports the rendering of pro-bono services. The fee scale below is an outline of the therapeutic services offered and their estimated costs.
CLIENT PAYMENT AGREEMENTClient Payment Agreement • November 11th, 2017
WI SHARES - PROVIDER/CLIENT PAYMENT AGREEMENTClient Payment Agreement • March 31st, 2022
This payment does NOT include extra charges that may be incurred for items including, but not limited, overages, late payment fees, field trips, and registration, as agreed upon in advance. Rising Sun must retain a copy of each current written payment agreement at the location where child care is provided. Rising Sun must retain a copy of an expired written payment agreement for 3 years after the agreement is terminated and the child no longer attends. The expired agreement may be kept at a location where it can be made available to the Department of Children and Families within 24 hours.
Client Payment AgreementClient Payment Agreement • April 4th, 2023
At JNG Health Network, we provide quality therapeutic services to children, adolescents, adults, and older adults at an affordable cost. We cooperate with all insurance providers in order to make payment for services more affordable and accessible to everyone we serve. JNG Health Network strives to be open and honest about all costs of services at onset, and accommodate Clients’ financial needs whenever possible. Clients are informed of their financial responsibilities prior to initiating the services. Consent to proceed is obtained by completing and signing the payment agreement. The fee scale below is an outline of the therapeutic services offered and their estimated costs.
