Release and Financial Responsibility Agreement Sample Contracts

RELEASE AND FINANCIAL RESPONSIBILITY AGREEMENT

Release and Financial Responsibility Agreement • June 26th, 2021

• Contract Type
  Release and Financial Responsibility Agreement
• Filed
  June 26th, 2021

Payment is expected at the time service is performed. We accept cash, personal checks with proper identification, Visa, Mastercard, Discover, American Express, Carecredit & debit cards.

Dr. John Y. Kim D.D.S., P.C.

Release and Financial Responsibility Agreement • July 20th, 2016

• Contract Type
  Release and Financial Responsibility Agreement
• Filed
  July 20th, 2016

Welcome to our office. We hope that this information form will answer some of your questions about our office’s financial and insurance policies.