Click button below to download appropriate forms.
When direct billing a credit card is required! No Exceptions!
The coverage & requirements of your plan is your responsibility please bring all that is required for your claim to ensure approval.
The form above is required by the program that I use to directly send the billing information.
Standard form required for all to fill out.
The form above gives me permission to direct bill your insurance provider for the services rendered
Daniel J. Fevreau, RMT
Relax and Enjoy.
Copyright 2013. Daniel J. Fevreau, RMT. All Rights Reserved.
These forms are ONLY needed for Direct billing.