PATIENT FINANCIAL AGREEMENT
Southern Crescent Family Practice is committed to providing patients with information regarding their coverageand financial responsibilities.
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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 firstname.lastname@example.org.