By checking this box signifies that you have read and understand our financial policy and HIPAA (Protected Heath Information Privacy) policy. Further, it acknowledges your responsibility regarding charges related to your care. You agree, to authorize us as your healthcare provider and/or any entity authorized by your healthcare provide, including those using automated dialing systems, automated messages, email, text messaging and/or other electronic communication to contact you for any reason by using any telephone number, email address and/or mailing address associated with your account.
