Financial Policy Form

Our office is committed to providing you with the best possible care. You are the single most important person making decisions regarding your health. After consulting with us, you ultimately decide whether a treatment is right for you. We have developed the following policy to assist you in understanding and managing your financial responsibility.

You may fill out and read our Financial Policy Form. After you have downloaded and filled out the form, please make sure to bring it with you on your visit.

Financial Policy Form

Technical Note:

Our downloadable forms use the Adobe Acrobat Reader to allow patients the convenience of completing their Financial Policy Form from home or work. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system. It is important that you have at least version 5 of the plugin, in order to successfully use our forms.

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