Patients that have Medicare, Medicaid, Blue Cross or Blue Shield DO NOT need to fill in the address
I acknowledge and agree that I have received and/or read a copy of Diagnostic Imaging Services of Idaho's Notice of Privacy Practices
Diagnostic Imaging Services of Idaho charges all patients an interest rate of 5.00% APR on past due amounts over 90 days. If your insurance has a deductible that hasn't been met this will apply to you. Interest will begin to accure 90 days after the date of service. If you have any questions about this policy or would like to set up a payment plan, call us at (208) 237-0977. Please sign below acknowledging that you have read and accept the interest rate terms as explained above.
We appreciate being able to serve you!