Financial Policies and Signature on File Agreement Sample Contracts

Mitchell & Mitchell, D.D.S. /P.A. Financial Policies and Signature on File Agreement

Financial Policies and Signature on File Agreement • March 7th, 2023

• Contract Type
  Financial Policies and Signature on File Agreement
• Filed
  March 7th, 2023

We will collect in full for Individual Insurance Plans or any COBRA Plan. We will file the dental claim and payment will be made to you from the insurance company. Payment is expected in full when services are rendered for non-insured or emergency treatment.

Mitchell & Mitchell, D.D.S. /P.A. Financial Policies and Signature on File Agreement

Financial Policies and Signature on File Agreement • November 23rd, 2021

• Contract Type
  Financial Policies and Signature on File Agreement
• Filed
  November 23rd, 2021

We will collect in full for Individual Insurance Plans through the online exchanges or any COBRA Plan; we will file the dental claim for reimbursement to you directly. Payment is expected in full when services are rendered for non-insured or emergency treatment.