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ZoomCare Financial Consent

Effective Date: August 20, 2025

1. Acknowledgment of Financial Responsibility

You acknowledge that you are financially responsible for and agree to pay for all services, fees, and products received or incurred from ZoomCare. Payment for services includes payment of applicable coinsurance, copayments, and deductibles for health insurers.

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2. Use of Your Credit or Debit Card

ZoomCare encourages you to provide your credit or debit card information at the time of scheduling. By providing your credit or debit card information, you are authorizing ZoomCare’s third-party payment processing vendor to retain your card information until your card expires or 12 months, whichever occurs first. You may revoke this authorization at any time by submitting a written request to ZoomCare at billing@zoomcare.com.

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ZoomCare accepts VISA, MasterCard, Discover Card and American Express. ZoomCare does not accept cash/check onsite, but payment may be made in person or sent to us at 11958 SW Garden Place, Tigard OR 97223.

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For any balance over $250, you will receive notification of being set up on a payment plan in accordance with ZoomCare’s payment plan policy. ZoomCare will also send you a receipt for all charges processed through the portal.

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3. Fee for No Shows

If you do not show up for your scheduled appointment, you may be subject to a fifty-dollar ($50.00) fee (“No Show Fee”). This fee must be paid in full before scheduling your next appointment with ZoomCare. If the No Show Fee prevents you from receiving care, please contact us (844)-966-6777 or email health@zoomcare.com.

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4. Billing Insurance & Assignment of Benefits Statement

You are responsible for providing ZoomCare with valid health insurance information at each visit. ZoomCare may ask your health insurer about coverage on your behalf. If you have health insurance, you authorize ZoomCare to accept direct payments from your health insurer. You consent to the necessary exchange of health information between ZoomCare and your health plan.

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4.1

If you qualify for benefits under Medicare or Medicaid, you authorize these program(s) to make payment directly to ZoomCare for your care. You are ultimately responsible for all fees for services received from ZoomCare, including any charges not reimbursed by your health insurer unless otherwise specified by state or federal law.

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4.2

If your primary health insurer and/or secondary health insurer does not pay ZoomCare timely, ZoomCare may then bill you directly or charge your credit or debit card on file the total amount due.

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5. Outstanding Balance and Collection Policy

Should your account be assigned to a collection agency, you agree to pay all legal costs and expenses, including reasonable attorney fees.

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6. Referrals for External Services

ZoomCare may recommend that you receive services, such as laboratory processing or testing or imaging services, at non-ZoomCare facilities. Any non-ZoomCare facility that provides you with services will bill you separately.

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7. ZoomCare Compliance

ZoomCare complies with all applicable federal and state laws and regulations, and does not discriminate on the basis of race, color, national origin, age, disability, or any other protected class.

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11958 SW Garden Place | Tigard, OR 97223
(844)-966-6777
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