I hereby authorize payment from the insurance company to be sent directly to Central Jersey Hand Surgery for any service rendered to me by the group.   I also authorize the release of medical information to my insurance company in order for Central Jersey Hand Surgery to complete necessary insurance forms. You are personally responsible for the payment of all bills, if your claim is denied (for any reason).  You are also responsible for any co-insurance amounts, non-covered charges and any balance remaining after insurance payment to our office. I am aware that the practice of medicine and surgery is not an exact science and I acknowledge that no guarantees will be given to me concerning the results of any treatment or operation. Doctors Pess, Decker, Gabuzda, Atik, Fedorcik and Ruskin will attempt to improve the patient, but cannot return the patient to normal status.