Contact Us

P: 541 815 4336

F: 541 833 0041

 

For a Verification of your health insurance benefits, please fill out the form below. Roots Billing will email an explanation of your benefits within 3-5 business days.

Name *
Name
Date of Birth
Date of Birth
Address
Address
Phone
Phone
Due Date
Due Date
Insurance # for Providers
Insurance # for Providers
Subscriber's Name
Subscriber's Name
Subscriber's Date of Birth
Subscriber's Date of Birth
Insurance # for Providers
Insurance # for Providers
Subscriber's Name
Subscriber's Name
Subscriber's Date of Birth
Subscriber's Date of Birth