Non-Covered Services AgreementCovered Services Agreement • June 10th, 2008
As your dentist, I want to provide you with your choice of dental services. There are may be certain services that you select that are not covered by your insurance company: Blue Cross Blue Shield of AL, Delta Premier, Dentanet, or Guardian.
RICHARD HEIDENFELDER, M.D.Covered Services Agreement • January 29th, 2014 • California
Welcome to our medical office. We are committed to providing our patients with the best possible care. Your clear understanding of our office and financial policies is very important, thus, we are available to discuss our professional services with you at any time. In addition to our office and financial disclosures, we value an open forum for a long-term physician-patient relationship. This Agreement is intended to communicate our practice values, adherence to strict consumer laws and all state and federal healthcare laws.
