| Messages to our patients concerning the Great Falls Clinic and our satellite offices. |
| Statement number - can be used to look up your account |
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Customer Service Phone Number |
| Statement closing date - the date that your statement was printed and the monthly cutoff date |
| Guarantor number/account number - used to look up your account |
| Your current balance as of the statement closing date |
| Your current billings address as of the statement closing date |
| The address of the Great Falls Clinic main facility |
| The date the services were provided, the provider who examined the patient, and the type of service received |
| Patient name - the patient on the account whose charges are listed (each patient will be listed separately) |
| The patient's history number with Great Falls Clinic |
| Previous balance, if any, carried forward from the month before |
| The price for each service |
| TP (Third Party) - indicates the Great Falls Clinic participates with this insurance carrier |
| The payment and adjustment applied to your account per individual service |
| The balance due from the listed date/s of service after insurance has processed |
| Statement closing date - the date that your statement was printed and the monthly cutoff date |
| The balance due from the listed date/s of service after insurance has processed |
| Indicates balance over 30, 60, or 90 days |
| Guarantor number /account number - used to look up your account |
| Your current balance as of the statement closing date |
| Statement number - can be used to look up your account |
| The address of the Great Falls Clinic main facility |
| Address change for you to fill out and return to our office for processing |
| Insurance change information for you to fill out and return to our office for processing |
| Option to pay by Credit Card on the back of your statement - we accept Visa, Mastercard, Discover Card and American Express (A credit card receipt will be mailed to you after this is received and processed in our office) |