I give permission for J.C. Healthcare & Associates, LLC to give me medical treatment.
2.I understand that J.C. Healthcare & Associates will not submit a claim for insurance benefits to pay for the care I receive, unless it is done at the discretion of the provider.
I understand that:
All services I receive must be paid by debit or credit card in full at
time of service.
It is my responsibility that if I have insurance, I will contact my insurance
company to discuss reimbursement of services paid for.
I must pay for the cost of these services if even if my insurance does not
pay or I do not have insurance.
3. I understand:
I have the right to discuss all medical treatments with my healthcare
I have the right to request to be seen or referred to another healthcare
provider such as a physician or nurse practitioner.
I have the right to refuse any procedure or treatment.