I understand that if the above is not true or if it is determined that I am not eligible under the terms of my Medical Insurance Plan, I am liable for all the charges for services rendered. Also, if the above is not true, I agree to pay in full for services received within 0 days of receiving a bill from Tri-City Healthcare Network. Fees for services rendered are payable at the time of service unless previous arrangements have been made. We accept assignments for Medicare and most insurance plans. I hereby authorize medical and billing to
be released to my insurance company.