Common Contracts
1 similar Payment Plan Agreement contracts
Payment Plan AgreementPayment Plan Agreement • June 15th, 2022
I, , the patient, (Account # ) understand that I am agreeing to the following payment plan between myself and River Cities Interventional Pain Specialists. I further understand that I must sign this agreement for it to be valid. All balances must be paid within the timeframe listed below. All unpaid balances 30 days or older will be considered for third party collections.
