UT Physicians Billing Assistance Form

UT Physicians Billing Assistance Form

Please complete the form below with detailed information regarding your billing inquiry. The billing department will reach out to you shortly.

Please note: If you are experiencing urgent symptoms, please contact your primary care physician or your nearest urgent care facility.

Patient's name*

Include the patient's first and last name.

Patient's date of birth*

Account number

Invoice number

Email address*

Phone number*

Phone

Billing inquiry:

Send me a copy of my responses

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