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General Financial Policy, CC Authorization, Consent to  Form

General Financial Policy, CC Authorization, Consent to Form

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Is required it is your responsibility to work with your primary care physician to obtain this referral prior to your appointment. AUTHORIZATION OF CARE I grant permission for Spine Joint Physicians to render such care that my physician may deem necessary in my diagnosis and treatment. If Spine Joint Physicians of Frisco is unable to verify your carrier has a referral on file your appointment may be rescheduled or you will be responsible for Self-Pay charges for the services rendered. PAYMENT OF...
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