Billing Services

Client Bill Type Transfer
Loading

Client Bill Type Transfer

Client:  Invoice Number:  Lab Code: 
Bill Type:  Patient Patient Name:  Specimen#: 
Collection Date: 
*Indicates Required Fields

Patient Information

Street address, P.O. box, company name, c/o

Apartment, suite, unit, building, floor, etc.

For Example: 12345 or 12345-6789
Date of Birth* Year

Responsible Party Information

Use Patient's Contact Information

  (Optional)

Street address, P.O. box, company name, c/o

Apartment, suite, unit, building, floor, etc.

For Example: 12345 or 12345-6789

Diagnosis Information

Diagnosis Codes




Your account can not perform the action you are requesting.

If you need assistance, please contact the billing customer service department.