due to tricare's new billing policies, we need more info!

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Unfortunately, due to new billing policies enacted by TRICARE, we need additional required information and paperwork before we are allowed to see you. We will call you back and schedule as soon as we can after receiving this completed form. If you have any questions, please call us at 937-550-9129. To reach our billing department directly, please call us at 937-550-9129 and click option 1. We will do everything we can to work with you and TRICARE so you may be seen.