Payment Policy and Financial AgreementPolicy and Financial Agreement • June 15th, 2015
Thank you for choosing Dee PT for your Physical Therapy needs. This financial agreement describes both patient and insurance responsibility for services rendered. Please read this agreement, ask us any questions you may have and sign in the space provided.
EAST VALLEY OPHTHALMOLOGY, LTD.Policy and Financial Agreement • October 23rd, 2007
Practice Policy and Financial AgreementPolicy and Financial Agreement • July 20th, 2020
❖ If you have dental insurance, we will gladly process your claims for you. We ask that you pay your expected portion and / or any deductibles at the time service is rendered with the understanding that you will be responsible for any portion of our fees that are not covered by your insurance company.
EAST VALLEY OUTPATIENT SURGERYPolicy and Financial Agreement • June 12th, 2020
Payment Policy and Financial AgreementPolicy and Financial Agreement • April 3rd, 2019
Thank you for choosing Dee PT for your Physical Therapy needs. This financial agreement describes both patient and insurance responsibility for services rendered. Please read this agreement, ask us any questions you may have and sign in the space provided.
Business Policy and Financial AgreementPolicy and Financial Agreement • June 12th, 2019
Welcome to Wiles Therapy Services, Inc. and SPOT On Therapy for Kids, LLC., where we work together as a team to provide quality, individualized OT, ST, and PT. Thank you for choosing us as your therapy providers, we are looking forward to working with you and your child!
Payment Policy and Financial AgreementPolicy and Financial Agreement • November 8th, 2024
Thank you for choosing Dee PT for your Physical Therapy needs. This financial agreement describes both patient and insurance responsibility for services rendered. Please read this agreement, ask us any questions you may have and sign in the space provided.
Payment Policy and Financial AgreementPolicy and Financial Agreement • September 8th, 2021
• Solutions for Mental Health, LLC is happy to process your insurance form for your reimburse- ment, but must be provided with appropriate proof of insurance. This is a courtesy we extend to you, but ultimately payment for all charges for care provided is your responsibility.
