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Treatment & Financial Agreement Welcome to the practice of Susan Trotsky, LCSW, and thank you for entrusting me with your mental health care. Please read the below information carefully, as it contains
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How to fill out treatment amp financial agreement

01
Gather all necessary information such as patient's personal details, insurance information, treatment plan, and financial obligations.
02
Clearly outline the payment terms and options available for the patient, including co-pays, deductibles, and payment plans.
03
Provide a detailed explanation of the services being provided, including any potential additional costs or fees.
04
Have the patient review and sign the agreement, ensuring that all terms are clearly understood.
05
Keep a copy of the signed agreement on file for both the patient and the healthcare provider.

Who needs treatment amp financial agreement?

01
Any individual seeking medical or dental treatment that involves financial obligations, such as co-pays, deductibles, or payment plans.
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Treatment and financial agreement is a document outlining the terms and conditions for medical treatment and payment responsibilities.
Both the patient receiving treatment and the healthcare provider offering the services are required to file the treatment and financial agreement.
To fill out the treatment and financial agreement, both parties must provide their personal information, details of the treatment to be provided, and agree on the payment terms.
The purpose of the treatment and financial agreement is to ensure both parties understand and agree upon the terms related to medical treatment and payment.
The treatment and financial agreement must include details of the treatment plan, cost of services, payment schedule, and any additional terms and conditions.
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