Thomas Paholak, D.P.M. Andrew O’Keefe, D.P.M. Jay Parsons, D.P.M
I or my representative, recognizing the need for care, consent to all and any services as ordered by my physician, including, but not limited to, laboratory tests, medical or surgical treatment, x-rays, examination, and other services rendered under the specific instructions of my physician.
Payment of your care. You are expected to pay any co-payment, non-covered or deductible amount. In addition to copays or deductibles, you are responsible for payment of denied or non-covered services as determined by the insurance company. Authorization or referrals for treatment are the patients’ responsibility. Failure to obtain the necessary requirements of your insurance will be the patient’s responsibility. Balance due upon receipt of the statement from our billing office.
You are not required to consent to receive text messages or email from Premier Podiatry Services. However, by providing your phone number and opting in, you agree to receive SMS / EMAIL communications about your inquiries, our services, or legal matters. Message and data rates may apply. You can opt out at any time by replying “STOP” to any of our messages. Please note that opting out may limit our ability to communicate with you about our services.
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