Forms

Welcome to The Robbins Health Alliance

We are proud to offer you Holistic Medicine

Forms

Register for your appointment now!!

This new feature allows you to enter your information for upcoming doctors visit. This will help ensure you get all your questions asked.
Click on: Register ME

Pay Balance on-line. Save Time.

If you are a private or self pay patient you may pre-pay for your visit. Our current patients can pay their outstanding balance on-line using paypal. This will help you avoid collection fees as your payment will be posted the same day in post cases. Co-payments are due at that time of service with out exception.

On-line Payment - Save time and money by paying your bill on-line today.

Credit Bureau

If your account has been turned over to the credit bureau a payment may still be made on-line. Your credit report will be updated upon receipt of your payment. Accounts reported to the credit bureau may result in termination from the practice.

Pre-register your insurance
with our Office

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Daytime Phone:

Email Address:
Date of Birth	Must be 21 or older

	Self Pay Patient
Insurance Plan:
Subscriber Number:
Group Number:
Group Name:
Deductible Amount::
Co-payment Amount:
Insurance Billing Address:
Comments:
	Our office does not accept Medicare, Medicaid and most HMO plans