Payment Selection AgreementPayment Selection Agreement • July 7th, 2020
The Fogarty Center d/b/a OPTIONS offers two (2) pay receipt options. Please check one (1) of the below options. If this form is not received by OPTIONS, during the initial enrollment phase, you will automatically receive a paper check.
Payment Selection AgreementPayment Selection Agreement • April 10th, 2023
The Fogarty Center d/b/a OPTIONS offers two (2) pay receipt options. Please check one (1) of the below options and complete all necessary information. Please see reverse side for additional information.
