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Direct Billing Consent Form

​Direct Billing Insurance Company Policy

We are happy to provide you with direct billing from your insurance company. Please provide the name of your employer, insurance details and a valid credit card to leave on file.

We kindly ask you to update our office with a current credit card if your card on file expires or is cancelled. Any credit card left on file will be used for all family members on the account unless specified below. Please also update our office with current insurance policy information so that we may submit your claims for payment. If there is a balance less than $200.00 after insurance has paid, this credit card will automatically be charged. For outstanding balances over $200.00, we will inform you before processing the balance.
​HOURS OF OPERATIONS:

Monday: 9:00am - 5:00pm
Tuesday: 9:00am - 5:00pm
Wednesday: 7:00am - 5:00pm
Thursday: 7:00am - 5:00pm
Friday: 9:00am - 5:00pm
Saturday: CLOSED 
Sunday: CLOSED 
CONTACT US

551-B Montreal Road,

Ottawa, Ontario
613-749-0003
[email protected]

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