Extended Payment Proposa

Submit your extended payment proposal online.

Extended Payment Proposal


We recognize that your time is valuable. Unfortunately it appears as if you are unable to meet your current payment obligations. As such, in an effort to make the payment process as easy as possible we have created an online form for you to submit an extended payment proposal to us. All payment proposal MUST be completed in <36 months. You will receive an email confirmation once this form has been submitted successfully. This does not indicate that your proposal has been approved. It will then be reviewed by the Billing Department. Unfortunately, your physician will NOT be involved in this proposal process.

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