Ready For My Specialist Appointment

Your Name

Your Email Address

I understand that seeing the U.S. Specialist is a private transaction between me and the specialist.

I understand that future costs of consultation, lab work or treatment will be discussed at the initial consultation with the physician.

I understand that the cost of this initial appointment will be payable in U.S. funds directly to the specialist at the time of my appointment.

I understand the VIP Docs Inc. is performing an administrative, not a medical service, and that the cost is $75 Canadian Funds payable online by credit card at the time I complete this form.

I understand that there is no assurance or guarantee that O.H.I.P. or any other agency or insurance company will reimburse me for the cost of this appointment.

I understand that transportation to and from the appointment is my responsibility - including my ability to legally cross into the United States.

I understand that it is my responsibility to keep the agreed appointment and that I am responsible for the cost of the appointment if I do not keep the appointment for any reason.

Questions or comment?

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Last updated March 04, 2008