Common Contracts
2 similar Patient Financial Agreement contracts
PATIENT FINANCIAL AGREEMENTPatient Financial Agreement • November 28th, 2016
Co-payments are due at the time of service. If you are unable to remit your co-payment amount, the office reserves the right to reschedule your appointment for another day/time that is convenient for you. If you wish to be seen at your regularly scheduled appointment the practice reserves the right to bill an additional $20.00 fee if the copay is not remitted by the end of the business day.
PATIENT FINANCIAL AGREEMENTPatient Financial Agreement • November 28th, 2016
Co-payments are due at the time of service. If you are unable to remit your co-payment amount, the office reserves the right to reschedule your appointment for another day/time that is convenient for you. If you wish to be seen at your regularly scheduled appointment the practice reserves the right to bill an additional $20.00 fee if the copay is not remitted by the end of the business day.
