I hereby authorize the medical group practice, Braun Dermatology & Skin Cancer Center P.C. or his agent to apply for benefits on my behalf for covered services rendered by Alicia D. Braun, M.D., Martin Alan Braun, M.D., Marisa A. Braun, M.D., Zetta Hester, M.D., Joseph Hudson, PA-C, or Gina DeBlasio, PA-C, and request payments from my insurance company be made directly to Braun Dermatology & Skin Cancer Center P.C.