Medical bill questions

Please fill out the form below and a member of our financial services team will contact you to address any questions or concerns. You can also call (888) 214-4066 for assistance.

Do not include any personal or sensitive information (credit/debit card numbers) with your submission(s).

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Patient information

First name

Last name

Street Address

Suite/building/apt #, City, State & ZIP

Date of birth

Facility name

Account no. (as found on your bill)

Need help finding your account number?

Invoice number

Found in "Summary of care" section of bill.

Your information

Your first name

Your last name

Your relationship to patient

Relationship

Your street address

Your suite/building/apt#, City, State & ZIP

Your date of birth

Your email address

Yes, I certify that I am the owner of the email account and am the patient, the legally responsible party for the patient's account, or I am authorized to act on behalf of the patient.

Message information

Subject

Message

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Medical bill questions

Patient information

Your information

Message information

Employees