• Out-of-Network Insurance Waiver

    I understand that I am covered under an insurance plan that the providers of Colorado Clinic do not participate with and I am choosing to obtain services that will be considered out–of-network. As such, I will be considered a cash pay patient.

    I have been informed and completely understand that I am fully responsible for the charges incurred, I accept financial liability and will pay at the time of service. I also understand that this will be for the duration of my treatment with Colorado Clinic or until my insurance carrier changes.