I agree to assign to sleep and health clinic any of my rights to be paid hospital or related charges by my insurers in respect of the current episode of treatment provided. Should there be any shortfall in payment by the insurer I understand that and agree to accept full liability. I unreservedly authorise disclosure of any medical notes including the provision of copies thereof to my insurer as part of their claim and payment processing requirements.
Cancellations made within 5 working days of an appointment will not be subject to penalty. Cancellations made within 4-2 working days of an appointment will be subject to 20% of the appointment cost. Cancellations made in less than 2 working days will be subject to 40% of the appointment cost. A new appointment can be rescheduled free of charge to the client, subject to availability.
I fully understand that being insured does not mitigate my responsibility to settle the account rendered in full and within the terms stipulated in this form and on the invoice. I understand that the account will be referred to Sleep and Health Clinic recovery agents if unpaid immediately thereafter and that all the above details will be made available to said recovery agents. This authority is unconditional and irrevocable.
Note for the purpose of security Sleep and Health Clinic reserves the right to instruct an appropriate agency to verify the address. Such information may be recorded on the agency’s file and may be shared with other users. I understand that if I am not a British Passport holder and am not ordinarily resident in the U.K. Sleep and Health Clinic reserves the right to contact the British Government missions overseas for the purposes of confirming and/or verifying the information provided by me and/or my next of kin, guarantor and/or my sponsor for visa purposes.
