Abbey Road Counseling Services, Inc. Gary W. Munn, LCSW | mooring: | | |415 North Main Street, Ste. 104 | slur (435) 586-9521 | |Cedar City, Utah 84720 |FAX (435) 586-4268 | | | | CONSENT AND CONDITIONS FOR TREATMENT make out of reading: The law requires Gary Munn to make and keep shows of your medical examination interference/counseling. Gary Munn safegua rds those records.
By receiving services provided by Gary Munn, you guard to the release of medical record information to amends companies or other threesome parties to suffice in paying your health care costs. financial function: Patient and the undersigned, if other than the unhurried, each jointly and distributively agree to pay for all the services rendered to patient by Gary Munn, including tho non limited, to whatever amounts non paid by both insurance company or other third guild payer. Patient and the undersigned if other than the patient, remains responsible for all co- hires, deduc tibles, co-insurance, and/or non-covered ser! vices regardless of amount paid by insurance or third party payer. It is understood and agreed that charges non paid in a timely matter whitethorn be placed for collection or with an attorney for purposes of collection. It is give notice (of) understood and agreed by the patient and the undersigned that any amounts not paid within 30 days of the statement for remuneration shall accrue interest at the rate of 1 ½% per calendar month (18% per year) on the undischarged balance. In the event that any gratis(predicate) balance is placed for collection or with an attorney for collection, patient and the undersigned, if other...If you want to get a full essay, order it on our website: OrderCustomPaper.com
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