Dispute My Account

Have questions about your account? If you would like to dispute your account, please fill out the form below and we’ll get back to you with more information.

Dispute My Account

If you received a collections notice that you feel is incorrect, please fill out the form to dispute your account. We will review your account and contact you with more information.

Your Account Number (listed on your letter)(Required)

Creditor (e.g. hospital or doctor named on letter)(Required)

Balance(Required)

First Name(Required)

Last Name(Required)

Street Address(Required)

City(Required)

State(Required)

Zip Code(Required)

Last four digits of Social Security number(Required)

Cell Phone(Required)

Email(Required)

Please provide reason for dispute(Required)