New Patient Registration (Health Insurance)

I hereby give consent to receive appropriate medical care and treatment from Bridge To Life Clinical Consultant

l also agree to receive automated text, voice messages or email reminders of scheduled appointments and invoice statements including promotional offers at the phone numbers, mailing and email address listed above. I understand that I am financially obligated for payment of all services rendered. Should I default on payments for
services deemed as my responsibility, I understand that collection efforts will be activated. No refund will be expected on my part or made once services are rendered and completed.