Consent and Authorization. ● I authorize dental treatment and agree to pay all related professional fees. Fees not covered by my dental insurance are considered professional fees and will be promptly paid by me upon notification from ▇▇▇▇ Dental. I have read and understood this document in its entirety, outlining office and financial policies of ▇▇▇▇ Dental Associates LLC.
Appears in 2 contracts
Sources: Financial Agreement, Financial Agreement