Patient Financial Obligation Agreement
I understand that all applicable copayments and deductibles are due at the time of service. I agree to be financially responsible and make full payment for all charges not covered by my insurance company. I authorize my insurance benefits be paid directly to MAR-NIG MANAGEMENT LTD / DR. NIGEL BARKER for services rendered. I authorize representatives of Warrens Eye Care Centre to release pertinent medical information to my insurance company when requested or to facilitate payment of a claim.