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    **Please complete the following form to contact your billing department. Only submit your information once. Duplicate entries will be removed automatically by our system. If you would like to follow up on your submission, please call our billing department, do not submit another entry. Thank you.
    FOR ALL REFUND REQUESTS PLEASE ALLOW 60 DAYS FROM THE DATE OF SERVICE TO REQUEST STATUS UPDATE.**

    I need to contact the billing department regarding:


    Book Appointment