Client Registration and Financial Agreement

Payment
The client will pay all fees and costs associated with the Services. Payment may be made via cash, MasterCard, Visa, check, or Care Credit and is due at the time that the Services are rendered. In the event that Client does not pay at the time that the Services are rendered, an interest fee of 1% per month (12% per annum) and an additional billing fee will be charged to Client. In any dispute arising from or relating to this Agreement, the Parties will resolve the dispute only in the state and federal courts for Roanoke County, Virginia. In any such suit in which the Hospital prevails, the Hospital will be entitled to recover all costs incurred, including reasonable attorneys’ fees.

Publicity Release
The Client acknowledges that the Hospital may at times take photographs of the Client and/or the Patient for purposes of marketing and promotion of the Hospital’s business. By checking the “Accept” box below, the Client consents to the unrestricted use of its name, likeness, and image for such purposes, and any purposes related to the Hospital’s business. The Client further acknowledges the Hospital will provide no payment, royalties, or other form of compensation to the Client in exchange for the use of the Client’s likeness for such purposes.