HopeCare Women's Health Services, LLC

Patient Name: Samantha Hages Date of Birth: Mar 14, 1997 Phone Number: (803) 555-0199 Account #: 99543210-0 Ticket #: 1049-22458

Full payment for all services is required prior to receiving services or treatment. It is patient/guarantor's responsibility to verify if HopeCare is in network with their insurance plan. Due to the nature of medical services provided and supplies used, refund requests are approved on a case-by-case basis. Typical cancellations must be made 24 hours before the scheduled appointment for eligibility for a refund or credit. Thank you for choosing us.