A-1 Chiropractic
Consulting & Supply

Product 114

Financial Arrangement Form

For those patients who have limited Chiropractic insurance coverage and difficulty in affording the full amount the insurance doesn't cover, even over a long period of time. This form allows you to give the flexibility where needed, without being subject to insurance fraud or jeopardizing possibly the next year's claim.
Pricing is as follows:

Quantity:	100	300	500	1,000
Price (USD):	$9.50	$15.50	$19.50	$39.50

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Product 114