Greensboro Radiology | for patients | Billing & Insurance

Attorney Balance Request

This request is for account balance inquiries only. For billing or insurance questions, please call (336) 274-4285 or email customerservice@gsorad.com. For status of requested records or itemized bills, please contact HealthPort directly at 1-800-367-1500.

All balance requests require 24 hour notice and will be faxed back within 24 hours. Requests for medical records or itemized billing statements should be faxed to 336-274-8097.

* All fields are required

* Attorney Name:
* Attorney phone number:	(xxx-xxx-xxxx)
* Attorney fax number:
* Contact Name:
* Contact email address:
* Comments:
* Patient Name:
* Patient DOB:	(mm/dd/yyyy)
* Patient Account Number:
* Patient DOS for balance requested:	(mm/dd/yyyy)