The spam filter installed on this site is currently unavailable. Per site policy, we are unable to accept new submissions until that problem is resolved. Please try resubmitting the form in a couple of minutes.

Reply to comment

I would not accept this

If a patient came in carrying this form, I would not take them as a patient. Again, I do not decide on fees, Medicare and Insurance Companies do.

Reply

The content of this field is kept private and will not be shown publicly.
  • Lines and paragraphs break automatically.

More information about formatting options