11. Responsible Party: If the patient is a minor, the person signing these forms agrees to be listed as the Guarantor and accepts sole financial responsibility for services rendered by Family First Physicians.
Please feel free to discuss any concerns you may have with our office staff. Our staff is dedicated to making your visits with us as pleasant as possible. It is your responsibility to know what is covered by your insurance plan as well as being financially responsible for any services denied or not covered by insurance.
Regardless of any personal arrangements that a patient might have outside of our office, if you are over 18 years of age and receiving treatment, you are ultimately responsible for payment of service. Our office will not bill any other personal
I agree to pay all finance charges, late fees, collection costs, attorney fees, and any other costs that may be incurred to enforce the collection of any amount outstanding.
I have read, understand, and agree to the financial policy stated above and accept responsibility for all payment of all fees/charges incurred with Family First Physicians.