Authorization Form

Treatment and Financial Policy

    Client & Patient Information

    TREATMENT AUTHORIZATION and INFORMATION/PHOTO RELEASE

    FINANCIAL POLICY

    Payment is due as services are rendered. The balance will be due upon discharge from the hospital. You may pay by cash, Care Credit, or accepted credit cards.

    In order to avoid misunderstandings, please let us know immediately if these terms are not satisfactory. In the event payment is not made at the time of service, it is our policy to apply a service charge to accounts with a balance.




    Patient Forms