Medical Arts Press® Financial Agreement And Insurance Assignment; 4×5-1/2″ Bond Non-Personalized

$2.79

SKU: 131380 Categories: Financial and Medicare Agreements, Medical Forms & Books, Practice Front Desk Supplies Tags: Financial and Medicare Agreements, Medical Arts Press

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Description

Form certifies that patients are responsible for all fees, regardless of any insurance reimbursement. By completing and signing this form, patient agrees to pay all fees at the time of service. Printed in black on white 20 lb. bond.

100 sheets per pad
Pad size: 4 x 5-1/2 inches

# Up Per Sheet/Page : 1	Binding Type : Padded	Brand : Medical Arts Press	Carbonless : No
Customizable : No	Form Size : 4″ x 5-1/2″	Form Type : Clinical	Format : Medical Authorization Form
Holes Punched : None	Media Quantity : 500	NCR Paper : No	Number of Parts : 1
Numbered : No	Personalization : No	Security Features : No	Sheet Size : 4″ x 5-1/2″
Weight : 1.00 lbs. per Pad