Billing Inquiry

Submit a Billing Inquiry

First Name *

Last Name *

Account Number *

Date of Service *

Phone Number *

Email Address

Mailing Address

City

State

Zip Code

Choose Facility *

Detailed explanation of issue/concern *

Is it okay that we contact you about this matter?*YesNo

By clicking this box you agree to allow Duke LifePoint to use your comments in any public channels such as on the organization's website or in advertising materials. If you click this box please provide us with your name and phone number so that we may notify you. *YesNo