I authorize any holder of medical or other information about me to release to the insurance companies any information needed to determine these benefits or benefits for related services . I also authorize the payments from these insurance companies to be paid directly to Somnos Laboratories Incorporated for services provided. I realize I will be responsible for any amount the insurance company does not allow for the services. To the best of my knowledge , the facts stated herein are complete and true.
I hereby authorize Somnos Laboratories Incorporated to obtain any medical information or records which will aid in the diagnosis or treatment of my illness. I also authorize Somnos Laboratories Incorporated to release any information acquired in the use of my testing to other physicians or to insurance companies .
Patients must provide at least 24 hours’ notice to cancel or reschedule an appointment. If you cancel less than 24 hours before your appointment or fail to show up without notice, you will be charged a non-refundable fee of $35. This fee is not billable to insurance and must be paid prior to your next appointment.
I give consent to SOMNOS to send me emails and text messages regarding my account.
