I promise to pay Charleston Anesthesia Group, L.L.C. for the Health Care Services received.

I agree to make payments in the amount listed below by the 15th of each month until my account is paid in full.

I understand that there will be no interest added to my account balance as long as I continue to make scheduled payments. Failure to make scheduled payments may result in my account being transferred to a professional collection agency.

In the event of default in the payment of this note or if it is sent to an agency for collection, the undersigned hereby agrees to pay for all costs of collection, including attorney fees.