Physician's Practice Bills
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How to Read Your Physician's Practice Bill
Account Number
Your patient account number is listed here.
Credit Card Slip
If you wish to pay by mail using a credit card, please complete this form, detach at the red line, and return it to the billing address as shown on your bill
Detach for Mail-In
Fill in and return the part of the bill above the red line with your credit card information, check, or money order.
Amount Due
Amount due during this billing period. Please enclose a credit card authorization, check, or money order for this amount with your payment.
Who to Pay
Make checks out to physician's office listed here. Payments should be sent to this address.
