I authorize the release of any information required by my insurance(s) for proper reimbursement to PSIMED, INC. and direct payment by insurance to such provider. I understand that all co-payments, deductibles, co-insurances and non-covered service amounts are my responsibility and due at the time of services. I have read and understand the Financial Policy/Authorization to Treat & No Show/Late Cancellation Policies provided to me, which are part of my patient record.