Good Faith Estimate

Effective Date: January 23, 2026

Under the No Surprises Act, you have the right to receive a Good Faith Estimate of expected charges for healthcare services if you do not have insurance or choose not to use insurance.

What Is a Good Faith Estimate?

A Good Faith Estimate provides an estimate of the expected charges for scheduled services. The estimate is based on information known at the time it is provided and may change if services or circumstances change.

Your Rights

If you receive a bill that is at least $400 more than your Good Faith Estimate, you may have the right to dispute the bill.

How to Request a Good Faith Estimate

A Good Faith Estimate will be provided:

• Upon scheduling services, or

• Upon request before scheduling

Questions or Disputes

If you have questions about your Good Faith Estimate or believe you have been billed incorrectly, contact us at info@drboulware.com

You may also visit www.cms.gov/nosurprises for more information about your rights.