Consent and Authorization. I authorize dental treatment for myself (or minor child) and agree to pay all related professional fees. I agree to pay any estimated copayments at the time of service. I understand that I am financially responsible to pay any insurance claims denied by my insurance company, regardless of the reason. I understand my insurance is my responsibility, and I do not hold Franklin Dental Associates responsible for any errors or omissions made by my insurance company.
Appears in 2 contracts
Sources: Financial Agreement, Financial Agreement