Print for Check Payments
Fees Schedule and Mailing Information for Doctors who want to pay by CHECK only. Please PRINT THIS PAGE, fill out top portion and check the boxes below, add up your total, and mail check along with this form to the consultant's address below.
Dr. Jones will respond as soon as we receive your check. Thank you.
Please fill out the information below. Dr. Jones will take a look at your case file. All fields are required!
Dr's. Email Address:
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