Patient Authorization to Treat Form
Call (727) 851-6160 for an appointment time prior to booking
- 5 min5 minutes
- Location 1
Midnight Medicine Disclaimer: I understand that I am financially responsible for professional services rendered by Midnight Medicine, Inc. I understand this service is non-refundable for any reason. I understand that Midnight Medicine assumes no liability for any third party laboratory laboratory-associated failures, whatsoever. I authorize Midnight Medicine, Inc. to use and disclose protected health information, as necessary, to carry out third party treatment, payment and healthcare operations.
This service is non-refundable for any reason per the terms of our office policy.
6705 38th Ave N, St. Petersburg, FL 33710, USA