THIS CLIENT PORTAL ALLOWS CURRENT CLIENTS TO VIEW THEIR BILLING INFORMATION AND SCHEDULED APPOINTMENTS, AND TO REQUEST EMAIL AND TEXT NOTIFICATIONS REGARDING UPCOMING AND CONFIRMED APPOINTMENTS WITH DR. JONES.
CREDIT CARD AUTHORIZATION
Current clients can opt to pay for services with cash, check, or credit card. For clients wishing to pay via their Health Saving Account (HSA) or credit card, please use the following form. Once completed, please email it to email@example.com, or bring it to your next appointment.
Click Here to download the Client Credit Card Authorization Form
CLIENT RELEASE OF INFORMATION
All communications with my clients are strictly confidential and protected by HIPPA. Current client who request that I release personal information (ex. speaking with insurance or other health care providers, writing letters , providing documention of services, etc.) must fill out the following form. Once completed, please email it to firstname.lastname@example.org, or bring it to your next appointment.
Click here to download the Client Release of Information Form
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