2. I allow Restore Health KY to file for insurance benefits to pay for the care I receive.
I understand that:
- Restore Health KY will have to send my medical record information to my insurance company.
- I must pay my share of the costs.
- I must pay for the cost of these services if my insurance does not pay or I do not have insurance.
3. I understand:
- I have the right to refuse any procedure or treatment.
- I have the right to discuss all medical treatments with my clinician.