OFFICE AND FINANCIAL POLICY AGREEMENT & CLIENT BILL OF RIGHTSOffice and Financial Policy Agreement • November 5th, 2024
Thank you for choosing Therapeutic Services Agency, Inc. (TSA) as your mental health care provider. The following is a statement of our Office and Financial policy. You will acknowledge your agreement to these policies on a separate signature page. This signature page will become a part of your health record. We are happy to discuss further questions or remaining concerns you may have now, or at any time in the future.
Office and Financial Policy AgreementOffice and Financial Policy Agreement • December 22nd, 2022
Thank you for choosing Surgical Group of Arizona for your medical care. We are committed to providing you with quality, personal health care and appreciate your commitment to adhering to this Office and Financial Policy Agreement. By understanding our policy, we can provide you with the best service. Agreement with this policy is required for all medical care.
OFFICE AND FINANCIAL POLICY AGREEMENTOffice and Financial Policy Agreement • February 17th, 2023
Thank you for choosing Therapeutic Services Agency, Inc. (TSA) as your mental health care provider. The following is a statement of our Office and Financial policy. You will acknowledge your agreement to these policies on a separate signature page. This signature page will become a part of your health record. We are happy to discuss further questions or remaining concerns you may have now, or at any time in the future.
Office and Financial Policy AgreementOffice and Financial Policy Agreement • August 17th, 2021
Thank you for choosing Eastern Connecticut Ear, Nose & Throat, P.C. (ECENT) for your medical care. A copy of this policy is available on our website or by request at the office.
Office and Financial Policy AgreementOffice and Financial Policy Agreement • January 24th, 2017
Thank you for choosing Eastern Connecticut Ear, Nose & Throat, P.C. (ECENT) for your medical care. A copy of this policy is available on our website or by request at the office.
BRADENTON HEART CENTER, P.A. OFFICE AND FINANCIAL POLICY & AGREEMENTOffice and Financial Policy & Agreement • November 5th, 2014
Our goal is to provide you with high-quality and efficient care. There are many details involved in the process of payment for the services that you receive. In order for this process to flow smoothly, it is essential that you understand what information we must share with each other and with health insurance companies, and what both our responsibilities are.
Office and Financial Policy AgreementOffice and Financial Policy Agreement • November 2nd, 2022
Thank you for choosing Lighthouse Child and Family Services, Inc. (LCFS) as your mental health care provider. The following is a statement of our Office and Financial policy. You will acknowledge your agreement to these policies on a separate signature page. That signature page will become a part of your health record. We are happy to discuss further questions or remaining concerns you may have now, or at any time in the future.
Office and Financial Policy AgreementOffice and Financial Policy Agreement • June 18th, 2019
Thank you for choosing Eastern Connecticut Ear, Nose & Throat, P.C. (ECENT) for your medical care. A copy of this policy is available on our website or by request at the office.
