Questions About Your Bill

If you have questions about your account, please complete the following information and a billing specialist will respond as soon as possible.

DISCLAIMER: SUBMITTING THIS INFORMATION WILL AUTHORIZE SOPHIA MEYER FAMILY MEDICINE TO RELEASE PRIVATE INFORMATION TO THE E-MAIL ADDRESS/FAX/ADDRESS/PHONE NUMBER THAT HAS BEEN PROVIDED IN THIS FORM, THEREFORE RELEASING SOPHIA MEYER OF ALL LIABILITY IN RELEASING THIS INFORMATION.

* All Fields Are Required!

* Patient Name:
* Patient DOB: i.e. mm/dd/year
* Phone: i.e. 469-555-1212
* Your Email:
* Billing Question:
 

 

 

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