Personal Injury Financial Agreement Sample Contracts

TODD B. ANDREWS, D.C. 206 S. PLACENTIA AVE. PLACENTIA, CA 92870
Personal Injury Financial Agreement • May 12th, 2009

We would like to take a moment and welcome you to our office and assure you that you will be receiving the best of care available.

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Personal Injury Financial Agreement
Personal Injury Financial Agreement • March 18th, 2020

We would like to take a moment to welcome you to our office and to assure you that you will receive the very best care available for your injury. In order to familiarize you with the financial policy of our office, I would like to explain how your chiropractic bills will be handled.

PERSONAL INJURY FINANCIAL AGREEMENT
Personal Injury Financial Agreement • January 23rd, 2024

Please read the following very carefully as it concerns your financial responsibility to the Health Care Provider from whom you are about to receive Medical Care from. Please seek legal counsel.

Contract
Personal Injury Financial Agreement • January 5th, 2016

We would like to take a moment to welcome you to our office and to assure you that you will receive the very best care available for your injury. In order to familiarize you with the financial policy of our office, I would like to explain how your medical bills will be handled.

PERSONAL INJURY FINANCIAL AGREEMENT
Personal Injury Financial Agreement • March 30th, 2016

The state of Georgia is a no-fault state. This means that if you are involved in an auto accident, even if the accident is not your fault, each person is responsible for their own medical bills until you file against the other driver's insurance in a settlement. We cannot submit your medical claims to the other insurance carrier because they will not pay us directly. They will only pay you upon a settlement.

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