1. Purpose of the Patient Financial Issues Section

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* 1. Facility Name:

In the following pages, we ask several questions regarding the finances of your patients. We recognize the sensitive nature of this information and only seek it to assist you in developing a financially sustainable radiology practice. All information collected in this financial section will be kept strictly confidential unless you provide us with permission to do otherwise.

Our shared goal is to provide the highest quality sustainable care to your patients by helping you:

1. Optimize your ability to serve more patients in your community

2. Create options to make radiology more accessible to your patients

3. Design marketing tools to help educate your community about the potential benefits of radiology

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