Vibrance Policy Forms

• Payment Policy

Thank you for choosing us as your healthcare provider. We feel strongly that all patients deserve the very best medical care we can provide. Everyone benefits when financial arrangements are agreed upon in advance, so we have prepared this material to acquaint you with our policy. If you have any questions, please be sure to ask BEFORE you sign this document. Payment of all co pays, deductibles, coinsurance, and any other amount not covered by insurance is due at the time of service. Full Document

• Consent for Treatment Policy

I consent to the Medical treatment deemed necessary by the health care provider(s) of Vibrance Internal Medicine upon my presentation. I consent to the disclosure of any information to outside providers or agencies involved in my treatment as deemed necessary by my Vibrance Internal Medicine provider(s), or if such disclosures are required or permitted by law. I consent for Vibrance Internal Medicine to release any information required in the course of my examinations and treatments for the purposes of insurance and/or Medicare benefits payment. Workman’s Compensation claim information may be released to my employer. I consent to assignment of payment directly to Vibrance Internal Medicine of all medical benefits applicable and otherwise payable... Full Document