By providing the information on this form, you agree to the following:
- I authorize my insurance carrier to exchange information required to process my claims.
- I understand that I am financially responsible for any balance after insurance.
- I agree to be contacted using the methods provided above unless I instruct Dr. Turnbull otherwise.
- I have reviewed online or have received copies or access to Dr. Turbull's Notice of Policies and Practices to Protect the Privacy of Your Protected Health Information; Confidentiality and It's Limits; and Client Services Agreement.
I am aware that I can ask questions at any time.