home
schedule an appointment
chiropractic
acupuncture
PRENATAL CARE
sports rehabilitation
massage therapy
community
paying for treatment
purchase a gift card
Excercise Database
store
footlevelers
Espanol
home
schedule an appointment
chiropractic
acupuncture
PRENATAL CARE
sports rehabilitation
massage therapy
community
paying for treatment
purchase a gift card
Excercise Database
store
footlevelers
Espanol
Payments for checks received for medical services
How to use this option:
Submit this form with the check(s) or other payments made by your insurance carrier
Deposit any checks you received
Once the checks are confirmed from us you will receive an invoice
The electronic invoice will be emailed to you, allowing payment through debit/credit card, google and apple pay.
*
Indicates required field
Policy Holder Name
*
First
Last
Email
*
Phone Number
*
Check Number (if multiple use comma to separate)
*
Check Amounts (if multiple use comma to separate)
*
Submit