Get Boone Hospital Center Price Estimate Request Form

Filling out the Boone Hospital Center Price Estimate Request Form online is an essential step for individuals seeking cost estimates for medical procedures. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your price estimate request form.

1. Click ‘Get Form’ button to access the form and open it for completion.
2. Enter the date in the designated field at the top of the form.
3. Fill in the patient name, ensuring to provide complete and accurate information.
4. Provide the address, including both address lines if necessary, as well as the city, state, and zip code.
5. Input the primary phone number and alternate phone number, if applicable.
6. Indicate your preference for receiving the written estimate by selecting either mail or fax.
7. Specify if you would like a verbal estimate in addition to the written letter by selecting 'Yes' or 'No'.
8. If available, enter the physician’s name for reference.
9. Describe the procedure you are inquiring about in the provided field.
10. If you have CPT or procedure codes, include them in the designated area.
11. Select whether the procedure is for inpatient or outpatient treatment by checking the appropriate box.
12. Choose if this is a self-pay or insurance request by checking the relevant box.
13. If applicable, provide the insurance plan information.
14. Review all filled-out information for accuracy before submitting.
15. Return the completed page to Boone Hospital Center at the specified address or fax it to the provided number.

Complete your form online today for a prompt price estimate.