The above information is true to the best of my knowledge. I understand that I am financially responsible for any balance due. I also authorize Sperling Radiology, PC and my insurance company to release any information required to process my claims. I have read and understood Sperling Radiology's HIPAA and Privacy Policies. I certify that I am aware follow up MRIs and Biopsies are at an additional cost and NOT included in the Laser Ablation Fee. I understand that lab fees, if any, including pathology fees are billed to me directly by the lab and are an additional cost. Before signing please ask staff questions you may have.