Online Billing Question Form

(Fields noted by * are required fields)

First Name*
Last Name*
Email
Account Number
Phone*
Insurance:
If child, name of parent or guardian:
Provider that the question involves:
Date of Service:
How can we help?**

** Please note that this is not a secure email transmission site. The Sinus Institute at CEI is committed to protecting your privacy as per the federal HIPPAA guidelines. Do not transmit information of a private or personal nature. If you are uncomfortable with this email contact form, contact us directly via phone or fax.

If you are a current patients and have a question for your provider, please use our secure system here. NOTE: this is ONLY for current patient of CEI.