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Genesys Bill Inquiry

Note: For purposes of Patient Confidentiality you must submit information for any bolded item. Inquiries with incomplete information (or unverifiable) will be disregarded. All inquiries will be answered via US Mail and sent to the address given during the hospital registration.

If you prefer to talk with a collection representative, please call (888) 544-7737.

Patient's Personal Information:

Patient Name:
Patient Treatment Date:
Last 4-digits of patient social security number:
GRMC Account Number (11 digits):
Your Personal Information:
Your Name:
Relationship to the Patient:
Your Email Address:
Your Phone Number:
Best Date/Time to Call:
Comments or Questions:
Would you like to receive emails from Genesys in the future?

If you are acting on behalf of the patient, by sending this request for information you are advising the Genesys Billing Department that the patient has authorized you to receive this E-MAIL information.


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