PATIENT FINANCIAL OBLIGATION: I acknowledge that I was provided with the Patient Financial Policy and understand all applicable copayments and deductibles are due at the time of service. I agree to be financially responsible and make full payment for all charges not covered by my insurance. I authorize my insurance benefits be paid directly to Oasis Physical Therapy, LLC for services rendered and authorize the release of pertinent information to my insurance company when requested or to facilitate payment of a claim.
NOTICE OF PRIVACY PRACTICES: I acknowledge that I was provided a copy of the Oasis Physical Therapy Notice of Privacy Practices.
