Patient Billing Form
For your convenience we offer secure third party insurance billing. If you would like us to bill your insurance directly for your treatment, please download and complete the E-Claims Consent form and send the completed form back to us using the “SEND FORM” button. Our office staff will review the form prior to your arrival.
NOTE: The "SEND FORM" button may fail to function with some web browsers. In this case, please save the PDF and email the forms to firstname.lastname@example.org as an attachment.
If you have any questions, feel free to email us at email@example.com or call our clinic at 1-403-239-4048 ext 230.
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