I authorize Hello Doctor Clinic to submit my medical claims and bills to the relevant insurance company, TPA, or corporate panel for treatments received at any Hello Doctor Clinic branch.

I understand that claim approval is subject to the terms, conditions, coverage limits, eligibility benefits, and final decision of the insurance company, TPA, or corporate panel.

I agree to fully pay any uncovered charges, rejected claims, deductible amounts, balance payments, or any amounts not paid by the panel.

I confirm that all information provided is true and accurate.