Get Fee Schedule And Financial Agreement

The Fee Schedule and Financial Agreement is a crucial document for users engaging with chiropractic services. This guide will assist you in accurately filling out the form online, ensuring clarity and understanding throughout the process.

Follow the steps to successfully complete the Fee Schedule and Financial Agreement

1. Click ‘Get Form’ button to access the Fee Schedule and Financial Agreement. This will open the form for you to fill out in the online editor.
2. Begin by reviewing the fee schedule, which outlines the costs for various membership options, including non-member, single, double, and family memberships. Ensure you understand the financial implications of each choice before proceeding.
3. Provide your personal information in the Member Entrance Form. This includes your last name, first name, date of birth, address, contact number, email, occupation, and number of children under 18.
4. Indicate your understanding and agreement with the financial policy by initialing where required. This signifies your acceptance of the membership rules and guidelines outlined in the document.
5. Read the Terms of Acceptance and confirm your agreement by signing and dating the appropriate section. This step ensures you acknowledge the specific practice philosophy regarding chiropractic care.
6. Complete the Informed Consent for Chiropractic Care by recognizing any risks associated with chiropractic treatment. Again, provide your signature and date after reading the conditions.
7. Once all sections are completed and reviewed, you can save changes, download, print, or share the completed form as needed for your records or to submit to the chiropractic office.

Start filling out your Fee Schedule and Financial Agreement online today for a seamless experience!