Common Contracts
3 similar Financial Agreement contracts
Financial AgreementFinancial Agreement • February 16th, 2017
I, understand that the Stram Center medical staff are non-participating with my current insurance plan carrier and therefore accept responsibility for payment of services at the time service is rendered. Furthermore, I understand that my current insurance plan will not be billed on my behalf for fees paid.
Financial AgreementFinancial Agreement • August 3rd, 2016
I, understand that the Stram Center medical staff are non-participating with my current insurance plan carrier and therefore accept responsibility for payment of services at the time service is rendered. Furthermore, I understand that my current insurance plan will not be billed on my behalf for fees paid.
Financial AgreementFinancial Agreement • May 13th, 2016
I, understand that the Stram Center medical staff are non- participating with my current insurance plan carrier and therefore accept responsibility for payment of services at the time service is rendered. Furthermore, I understand that my current insurance plan will not be billed on my behalf for fees paid.
