Need a Superbill?

Please fill out the form below to request a copy of your superbill. Superbills are documents needed by insurance companies to file insurance claims. We do NOT file insurance claims for you, this is the client responsibility.

Client Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email (Must be email address listed on client records)

Please send me a superbill.

Beginning Date of Services

MM

DD

YYYY

Practitioner Name

First Name

Last Name

Additional Requests

Need a Superbill?

Follow Along

940-294-7061

Notice

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We do not accept insurance at this time

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Notice 〰️ We do not accept insurance at this time 〰️