Memorial Sloan Kettering Cancer Center International Center Self-Pay Contract for Non-U.S. ResidentsSelf-Pay Contract • June 28th, 2020
Patient Address: Medical Record Number: Date of Self-Pay Contract: You are receiving this Self-Pay Contract (“Contract”) because MSK has determined that you do not haveSelf-Pay Contract • December 23rd, 2021
Kettering Cancer Center (“MSK”). If you choose to be seen at MSK, you must agree to this Contract. This Contract explains that you will be financially responsible to pay MSK for all charges related to the physician and hospital services that you receive here. The Contract also explains that all required deposits must be paid before being seen at MSK for care. Please note that you will be financially responsible for these amounts, whether or not your insurance plan may separately reimburse you for these services in the future. Please note that you are solely responsible for any separate obligations that you may have to notify your insurance plan or other third parties about the services that you receive here.
