Patient Payment Collection

After you have filled out your implementation worksheet, we will send the Patient Payment Collection form via email to the staff member you indicated was the best point of contact for this request.  All you need to do is fill out the following Practice Bank Account information, click submit, and we will take care of the rest!

Note:

In the event we are unable to verify your account information, we will reach out to the same point of contact to resolve. 

Account verification can take up to 24 hours, however normally this is completed same day

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