11 Years to 17 Years
Notice of Privacy Practices
Patient Consent and Acknowledgments
If the patient is covered by insurance, the following apply:
We expect payment in full at time of service for all charges which are not covered by the patient’s health plan. It is your responsibility to contact us in the event of a need for an alternative payment plan or to apply for a discount if you do not have insurance.
In the event of non-payment, you will be responsible for any legal and collections fees. Legal and collection fees will be added to the outstanding balance on the account should the account be referred to an outside agency for collection.
I have read and agree to the above terms and hereby assume full responsibility for paying any medical service charges and collection fees according to these terms.
Terminating the Physician-Patient Relationship and No-Show Policy
It is Barry Pointe Family Care a division of Signature Medical Group of KC’s desire to do our best to have the best applicable care for all our patient’s healthcare needs so we can keep the provider/patient relationship trustworthy and respectful.