File for Services Rendered

Name: Practice Management 101: Financial Road Map
Start: 2020-06-08T14:00:00-07:00
End: 2020-06-08T15:00:00-07:00
Location: From your computer

Your reimbursement is a few steps away...

IF YOUR CLIENT NO-SHOWED:
- CHECK HERE and complete the remaining required fields
Client Name*
First Last
Date of Service*
Date Format: MM slash DD slash YYYY
Service Obtained
What is your normal retail rate for this service? (numbers only)
Authorization Code from Client (note: if client does not present a code and no session was available, you are at risk).
Special instructions: if your client redeemed more than one YDW session with you, list all authorization codes in comments section.
Who should we make payment to?
Do you want your notification via text or email?
- Text message
- Email notification
Phone number for text message
We pay electronically within 1-2 business days of receiving your request. You will receive a text message stating "O'Malley & Associates LLC wishes to make payment to you" along with instructions on how to transfer funds to your checking account.
What email address should we send funds to?

We pay electronically within 1-2 business days of receiving your request. You will receive an email stating "O'Malley & Associates LLC wishes to make payment to you" along with instructions on how to transfer funds to your checking account.
Our payment system requires you to answer a Security Question; what question do you want it to ask?
What will be your answer to the Security Question?
Comments
Phone
This field is for validation purposes and should be left unchanged.

File for Services Rendered Denise July 10, 2016

File for Services Rendered

Your reimbursement is a few steps away...

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