Forms

Payment Plans:                                                                                                                                                                                                                                         
Please use the enclosed form to set up a payment plan agreement. The signed form may be faxed, emailed or mailed to Diagonal Medical Billing. You may also take the signed form to your doctor's office. A copy will be returned to you once the payment plan has been set. Thank you.


Medical Records Release:                                                                                                                                                                                                                       
Due to HIPAA regulations Diagonal Medical Billing is unable to discuss medical billing information with anyone other than the patient without a signed release. If you do not have such release on file with your doctor's office, please use the form below. The signed form may be faxed, emailed or mailed to Diagonal Medical Billing. You may also take the signed form to your doctor's office.
Once we have a release on file we will gladly assist the person you have requested to help with your account. Thank you.
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Robyn Marcotte,
Apr 20, 2015, 10:35 AM
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Robyn Marcotte,
Apr 20, 2015, 10:36 AM
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