Billing Inquiry
Our billing is handled in our own building, by our own team. Send your question here and a member of the billing team gets back to you - usually within one business day. Please do not include credit card numbers on this form. If a payment is needed, we'll arrange it securely when we contact you.
Patient name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
By signing up for text messages, you agree to receive informational messages (appointment reminders, account notifications, etc.) from Urology Associates of Cape Cod at the number provided. Message frequency varies. Msg & data rates may apply. If you require assistance, reply HELP, or you can call (508) 771-9550, ext. 121 or email us at contact@uacc.cc to reach our office. You can opt-out at any time by replying STOP. View our Privacy Policy.
I agree to receive text messages from Urology Associates of Cape Cod.
What's this about?
*
A charge or statement I have a question about
Setting up a payment plan
An insurance question about a bill
Updating my billing information
Something else
Account or statement number, if you have it
It's at the top of your statement — helpful but not required.
Your question
*
No credit card numbers, please.
How should we reach you?
*
Call
Text
Email
Email address
*
example@example.com
Contact consent
*
I agree to receive a brief confirmation message at the contact I provided above. I understand it will not contain medical details.
Submit
Should be Empty: