Weekend Health of Texas, P.A. and its affiliated entities are committed to providing the best quality healthcare services. We do not participate in any insurance plans, including Medicare, Medicaid, or any other federal health program and we do not accept any health insurance whatsoever. Our services are 100% self-pay by our patients. By signing this form, you acknowledge that you must pay for any services rendered by Weekend Health out-of-pocket.
If you are a beneficiary of Medicare, Medicaid, or any other federal health care program, services provided by Weekend Health are not reimbursable by your insurance plan and Weekend Health will not bill your insurance. You must pay for any services rendered by Weekend Health out-of-pocket without assistance from Medicare, Medicaid or any other federal health care program.I have read the Agreement for Self-Payment of Services.
I understand and agree to this Agreement.
