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Amount to be Paid: *
Six Digit Account Number
with our Agency Six Digit Account Number with our AgencySix Digit Account Number with our Agency: *
Name on Account Name on AccountName on Account: *
Time when we can call back: *
Please note: Stern CANNOT email any type of response back to the patient.
Comments:
Will you be paying with a flexible spending card and/or for a health savings account? * What is a FlexCard?