Patient authorizes payment of insurance benefits to be paid directly to Sleep Disorders Centers or
agrees to forward and payments issued by his Insurance for services rendered to Sleep Disorders
Centers.
Patient agrees to pay reasonable attorney fees and cost should a collection or suit be necessary to
collect payments issued to patients by the Insurance and not forwarded to Collin County Sleep
Diagnostics by Insured. Patient authorizes Collin County Sleep Diagnostics to release any information
acquired in the course of the diagnostics and treatment to his physician and for collecting on unpaid
services