Addiction Medicine SPECIALTIES

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Addiction Medicine View Doctors

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Non-Associate

Rohit Gupta

Phone: 9039732590

Non-Associate

Aaa Aaa

Phone: 9585455555

Associate

Rhi Hh

Phone: 8548548548

Non-Associate

Qwert Trewq

Phone: 9898989898

Non-Associate

Adad Adad

Phone: 9090909090

Non-Associate

Khawaja Khalil

Phone: +923015566247

Non-Associate

Rohit Gupta

Phone: 9658548745

Non-Associate

Fakhar Abbas

Phone: 3037492694

Non-Associate

Focor Ssdds

Phone: 46544646646

Non-Associate

Skied Skied

Phone: 841254879

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This Petition Slip is for you to present to the named Healthcare Provider as a written request for a price break on the office visit/service appointment which you are responsible to schedule. If a price break has not been determined prior to your appointment, feel free to remind the Healthcare Provider/staff that you are paying out-of-pocket that day. At this time it is important for you to ask the Healthcare Provider which form of payment they accept; Cash, Check or Charge.

PAYMENT DUE

When checking in at your appointment, payment will be required prior to receiving service.

HEALTHCARE PROVIDER

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SERVICE PRICE PETITION

Office visit/service price to be determined between Patient and Healthcare Provider

PROVIDER SIGN-UP

Please ask your Healthcare Provider to visit MEDPRICE.COM to review the enrollment process. Our basic program allows Healthcare Providers to enroll as an Associate starting as low as $9.95 per month. It is designed to eliminate the 'sometimes awkward' face to face price negotiations with patients and to simplify the out-of-pocket payment method.

Print this out and take it with you to your appointment.