Payment is due at the time of service for all self-pay patients. As a Self-Pay Patient, you have agreed to be treated at Local MD Urgent Care today by the Provider on schedule. You have been informed by the staff that by agreeing to pay the office visit price, you are entitled to be examined by the Provider on schedule. You have also been informed that should any further testing be necessary, per the Provider’s recommendation, you have the right to choose whether to accept or decline further testing. If you decline any further testing, you will not be liable to pay any additional amount than what you have already paid to be seen by the Provider. Should you choose to elect to receive further treatment at Local MD Urgent Care, you are liable to pay an additional amount based on the treatment provided.