Common use of Authorization of Payment Clause in Contracts

Authorization of Payment. I hereby authorize the provider of services to release information concerning my examination and/or treatment for insurance purposes and to receive direct payment for benefits payable to me for services rendered

Appears in 1 contract

Sources: Counseling Agreement

Authorization of Payment. I hereby authorize the provider of services to release information concerning my examination and/or treatment for insurance purposes and to receive direct payment for benefits payable to me for services rendered.

Appears in 1 contract

Sources: Psychotherapist Patient Services Agreement