Juniper on Behalf of TES Therapy

TES Therapy: Electronic Statements and Payments

Total Education Solutions has partnered with Juniper, our new client e-statement provider. Juniper will enhance your care experience by giving you the option to opt-in or out of electronic billing statements and make payments online. Please submit this 1-minute form below to confirm your contact information and indicate your statement preferences. Please note: if you do not opt-out of e-statements through this form, you will be automatically opted in.
Patient Services Policy:

To expedite your child’s care, claims will be submitted to insurance companies TES Therapy clinic is contracted with and any payment issued will be received by our clinic. Any remaining balance, deductibles, co-pays, or co-insurances will be your responsibility. Payments due for services are automatically collected via either your credit card or your ACH information on the last business day of the month.
Current email on file*
(Primary email on file with TES Therapy)
What is the best email address to contact you for statement-related questions?*
example@example.com
Juniper may send you e-statements (via email) rather than mailed statements. Please select "Yes" if you'd like e-statements and "No" if you'd like mailed statements. If you do not submit this form indicating "No," you will be opted in to e-statements*

YesNo
Juniper may automatically charge your card on file for any ongoing patient statements to reduce your time spent paying bills each month*

YesNo
Opting into e-statements constitutes an agreement with Juniper's e-statements terms and conditions.

This does not override any existing agreement you may have with your provider. Opting in to auto-charge card-on-file constitutes an agreement with Juniper's card-on-file terms and conditions.
Should be Empty:

TES Therapy: Electronic Statements and Payments

Patient Services Policy: