Get Cfc Financial Policy - Columbia Family...

Filling out the CFC Financial Policy form is a straightforward process that ensures your understanding of the financial obligations incurred while receiving chiropractic care. This guide will provide step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the form online.

1. Click the ‘Get Form’ button to access the CFC Financial Policy form and open it for editing.
2. Begin with the patient information section, where you will enter your full name and the name of your guardian if applicable. Ensure that all names are spelled correctly to avoid any potential issues later.
3. Next, review the policies outlined, particularly regarding your insurance coverage. If you have a participating insurance plan, fill in the details about your insurance provider and policy number.
4. If you are using a secondary insurance or a medical savings account, provide that information in the designated fields. This helps facilitate billing and ensures that you receive any potential reimbursements.
5. For patients without insurance, indicate your understanding of the payment requirements, specifically acknowledging your obligation to pay for services rendered entirely on the date of service.
6. Carefully read through the personal injury or automobile accident section if it applies to you. Fill in your auto insurance information and any details regarding your attorney, if relevant.
7. Lastly, sign and date the form where it indicates. This confirms that you have read and understand the financial policy, acknowledging your responsibility for any incurred charges.
8. After completing the form, you can choose to save your changes, download the document, print it for your records, or share it with the office as needed.

Complete your CFC Financial Policy form online today to ensure a smooth and transparent experience at Columbia Family Chiropractic.