New Patient Registration (No Insurance)

I hereby give consent to receive appropriate medical care and treatment from Bridge To Life Clinical Consultants, LLC. I also agree to receive automated text, voice messages or email reminders of scheduled appointment and invoice statements at the phone number and email listed above. I understand that I am financially obligated for payment of all services rendered. Should I default or refuse to make 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 ad completed. *