PATIENT QUESTION 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.