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Bone Density Exam

Carefree Internal Medicine

Seema Mohan, M.D. & Diana Hrdina, M.D.

Bone Density Exam Form

Bone Density Exam

We are about to perform your Bone Density examination, Your health insurance may not cover this type of service. If after filing a claim, your insurance company indicates that this Bone Density examination is not covered by your current policy, prompt payment will be expected from you.

If during the visit, the physician addresses a problem that would normally be submitted to your insurance company, both the Bone Density exam and the office visit charges will be submitted to your insurance.

If insurance does not cover the Bone Density Exam the cost is $50.00.

I understand and agree to the above.

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