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