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 PATIENT FINANCIAL AGREEMENT 

Southern Crescent Family Practice is committed to providing patients with information regarding their coverageand financial responsibilities. 

Click Here to Complete Form

Please save the form to your computer before filling it out. 

Please note that you will need to complete a digital form. You can submit this form to us using adobe acrobat. If you do not have adobe acrobat on your computer, you can install it by clicking this link: https://get.adobe.com/reader/ and following the prompts. 

 

Otherwise please fill out the digital forms and email them to nurses@scfp.llc.