Pay Bill - Bodyworks Physical Therapy

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PAY BILL

Patient ID*
Amount*
Billing Information
Billing Information*
Street Address City State ZIP Code
Phone*
Email*
Payment Information
Credit Card*

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

SPINAL CONDITIONS
ORTHOPEDIC CONDITIONS
DRY NEEDLING
WOMEN'S HEALTH
VERTIGO/DIZZINESS & BALANCE
POST-SURGICAL REHABILITATION

BLISS MASSAGE
HEADACHES
MANUAL THERAPY
TMJ DYSFUNCTION
INCONTINENCE
MUSCLE ACTIVATION

Request an Appointment

After submitting this form, a Bodyworks representative will contact you
to secure your appointment. If you need immediate scheduling assistance,
please call us directly at: 701-893-BODY.

Please note: We attempt to accommodate all appointment requests, but
appointments are not confirmed until you receive a call from our front office.

Thank You!

We have received your form and a Bodyworks representative
will get back to you within the next business day.

If you need immediate scheduling assistance,
please call us directly at: 701-893-BODY

Billing Information

Payment Information

Request an Appointment

Thank You!