Patient Payment/Credit Financial Agreement Sample Contracts

Contract
Patient Payment/Credit Financial Agreement • September 7th, 2023

The physicians of Digestive Health Clinic, LLC (DHC) are the owners of dba Nampa Digestive Health Clinic (NDHC), Idaho Endoscopy Center, LLC (IEC), and dba Nampa Idaho Endoscopy Center (NIEC). It is our policy to provide the finest quality and most effective medical care available. In order to do this, we must be sensitive to cost containment and utilize good practice management techniques. It is important for you to understand the charges that will be involved with your care and the payment of your bill is considered part of your treatment. The following is a statement of our Financial Policy which, we require you to read and sign. This will remain in effect for all services rendered during your time as a patient of DHC, NDHC, IEC and NIEC. If you have other questions about billing or insurance, please call our Patient Accounts Representative at 208-489-1836 Monday through Friday between 8:30 a.m. and 4:30 p.m.

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Contract
Patient Payment/Credit Financial Agreement • March 2nd, 2017

The physicians of Digestive Health Clinic, LLC (DHC) and Idaho Endoscopy Center, LLC (IEC) are the owners of the clinic and endoscopy center. It is our policy to provide the finest quality and most effective medical care available. In order to do this, we must be sensitive to cost containment and utilize good practice management techniques. It is important for you to understand the charges that will be involved with your care and the payment of your bill is considered part of your treatment. The following is a statement of our Financial Policy which, we require you to read and sign. This will remain in effect for all services rendered during your time as a patient of Digestive Health Clinic, LLC and Idaho Endoscopy Center, LLC. If you have other questions about billing or insurance, please call our Patient Accounts Representative at 208-489- 1836 Monday through Friday between 9:00 a.m. and 5:00 p.m.

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