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CREDIT CARD INFO FOR
OUTPATIENT SERVICES
THIS SECTION TAKES ABOUT 4 MINUTES TO READ & COMPLETE

IMPORTANT INFORMATION ON THE
PATIENT HEALTH INSURANCE BILLING PROCESS
YOUR INSURANCE: At the end of each month, your credit card will be processed to pay for the month's treatments.
We will then immediately send you a professional receipt for your insurance submission.
Once submitted, insurers usually take 48 hours to refund client.
A credit card pre-authorized deposit may be required before you begin your treatment for the first month,.

C R E D I T C A R D

MY INSURANCE INFO
Optional submission of insurance information for our records. We do NOT bill insurance directly - our experience has shown that insurers are affirmatively not optimally cooperative & user-friendly with clinics.
Direct billing would otherwise add costs to your treatments. When the client contacts the insurer for non-payment their response is significantly more inviting & service-focused.
If you would like the insurance information on your receipts please provide the information as outlined below. It is not a requirement, however, for your insurance submission processes.

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