I Have Filed Bankruptcy

We are sorry to hear that your financial situation has resulted in filing bankruptcy. Please use this form to supply the bankruptcy filing information so we can update your account(s) accordingly. Please make sure to add your healthcare providers to the list of creditors on your bankruptcy if you haven’t already.

Your Name *

E-Mail Address *

Account Number *

Case Number *

File Date *

This communication is from a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose.

Are you human? *