![](https://www.pdfsearch.io/img/583755cf8c5a483ac77e229e8c140cf2.jpg) Date: 2015-01-27 08:20:29
| | Main Street Medical FINANCIAL RESPONSIBILITY AGREEMENT Payment is required at the time of service. Payment may be made by cash, check or major credit card. Any deductible, co-insurance or co-payment is payable at theAdd to Reading ListSource URL: www.hiltonheadurgentcare.orgDownload Document from Source Website File Size: 46,39 KBShare Document on Facebook
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