Financial Release of Information Form Copied

Step 1: Updated to include only the disclosure notice. Users will no longer add contact information here.

Step 2: Clarifying statement added regarding the collection of patient’s Social Security number.

Step 3: Updated statements to:

• Allow users to consent to receive emails and texts about their financial statements.
• Acknowledge receipt and understanding of the Patient Billing form.
• Remove consent statements regarding the sharing of financial information with approved parties.