What is your preferred format for receiving medical bills?
Paper statements Digital/email Both Online portal Mobile app
How often do you prefer to receive medical bills?
Monthly Bi-monthly Quarterly Upon service Custom schedule
Which payment method do you prefer for medical bills?
Credit card Debit card Bank transfer Check Payment plan
How well do you understand your medical bills?
Very well Somewhat well Not very well Not at all I seek clarification
Have you encountered challenges with past medical bills?
Yes No
All set, how can we reach you?
Name
Email
Phone
(Details here)
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