Gary W. Munn, LCSW
| mooring: | |
|415 North Main Street, Ste. 104 | Office (435) 586-9521 |
|Cedar City, Utah 84720 |FAX (435) 586-4268 |
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CONSENT AND CONDITIONS FOR TREATMENT
Release of reading: The law requires Gary Munn to make and keep shows of your medical treatment/counseling. Gary Munn safeguards those records.
By receiving services provided by Gary Munn, you guard to the release of medical record information to amends companies or other third parties to suffice in paying your health care costs.
Financial function: Patient and the undersigned, if other than the unhurried, each jointly and severally agree to pay for all the services rendered to patient by Gary Munn, including tho non limited, to whatever amounts not paid by any insurance company or other third companionship payer. Patient and the undersigned if other than the patient, remains responsible for all co- hires, deductibles, co-insurance, and/or non-covered services regardless of amount paid by insurance or third party payer. It is understood and agreed that charges not paid in a timely matter may be placed for collection or with an attorney for purposes of collection. It is advertise understood and agreed by the patient and the undersigned that any amounts not paid within 30 days of the statement for payment shall accrue interest at the rate of 1 ½% per month (18% per year) on the undischarged balance. In the event that any unpaid 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: Orderessay
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