To complete this request, please send a secure email to

Required Email Subject: Refund Request

Information to include in your email:

  • First Name:
  • Last Name:
  • Patient Email:
  • Patient Acct #:
  • Invoice #:
  • Check:
  • Check Amount:
  • In body of email please add any additional information.

You may also fax the above details to 919-714-5235