Financial Agreement for Professional Services Sample Contracts

FINANCIAL AGREEMENT FOR PROFESSIONAL SERVICES
Financial Agreement for Professional Services • January 26th, 2012

Psychological services provided to you by Dr. Linda Dreke may be totally or partially covered by insurance or some form of managed care. Or, if you are uninsured or do not wish to pay with insurance, you may pay using Dr. Dreke’s sliding fee option.

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FINANCIAL AGREEMENT FOR PROFESSIONAL SERVICES
Financial Agreement for Professional Services • March 12th, 2012

Psychological services provided to you by Dr. Linda Dreke may be totally or partially covered by insurance or some form of managed care. Or, if you are uninsured or do not wish to pay with insurance, you may pay using Dr. Dreke’s sliding fee option. Payment for services may be made by cash or check (to “Dr. Linda Dreke”). A receipt will be provided.

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