Clients agree to sign over checks from insurance to my practice and authorize me to charge their credit card on file if for any reason the checks don’t materialize.

Your Order:

Insurance Reimbursement Agreement


By purchasing this product, you agreed to our terms and conditions.

Payment Information

Thank you for purchase!

We sent your receipt to your provided email address. We will also send a copy of Insurance Reimbursement Agreement to your inbox within 1 business day!

You can download the Insurance Reimbursement Agreement by clicking the link below!


If you have any questions, feel free to contact us at