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FORT MYERS FAMILY MEDICINE, P.A. 15661 SAN CARLOS BOULEVARD, SUITE 2 FORT MYERS, FLORIDA 33908 TELEPHONE: (239) 4334014 SELF SOLUTION MEMBERSHIP AGREEMENT Welcome to Fort Myers Family Medicine, P.A.
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Individuals who wish to engage in a self-pay solution for a particular service or product.
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Businesses or organizations offering self-pay options to their customers.
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The self-pay solution agreement 00033109-3doc is a document outlining the agreement between a payer and a healthcare provider for self-pay services.
The healthcare provider is required to file the self-pay solution agreement 00033109-3doc.
The self-pay solution agreement 00033109-3doc can be filled out by entering relevant information about the agreement between the payer and healthcare provider.
The purpose of the self-pay solution agreement 00033109-3doc is to establish the terms and conditions for self-pay services provided by the healthcare provider.
The self-pay solution agreement 00033109-3doc must include details about the services provided, payment terms, and any other relevant information.
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