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Pre-Collect   Forms

You will need the following information for each client on the accounts:

  • New client information forms  (contracts, patient forms, service agreements, etc)

  • Financial disclaimer which allows our office to add collection and / or attorney fees

  • Full name

  • Date(s) of service

  • An itemized statement of billing which includes balance due

  • Social security number

  • Date of birth

  • Address

  • Home phone number

  • Cell phone number

  • Work / Alternate phone number
     

 Pre-Collect   New Account   Placement 

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