Patient Form

This form can be used to answer simple billing questions.  Please complete the form entirely.  A representative will answer your question via email within 2 business days.  If your question is deemed complex, the representative will not email you back, however we will telephone you within 2 business days after researching your account.  By submitting this form you agree that personal health information may be sent over the internet which is not HIPAA Compliant.

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