Your Practice Name
123 Your Street
Yourtown, US 12345
January 1, 2011
Mr. John Doe
100 Deere St.
Yourtown, US 12345
Dear John,
We are in the process of updating your file and would like to verify the information we currently have.
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Home Phone |
123-4567 |
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Work Phone |
987-6543 |
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Employer |
Business Enterprises, Inc. 123 Maple Dr. Yourtown, US 12345 |
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Primary Insurance |
Mutual Benefits |
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Remaining Benefit |
$265.00 |
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Last Visit Date |
February 2 , 2010 |
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Last Payment |
$125.00 March 12 , 2010 |
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Account Balance |
$0.00 |
If you see any errors in the above would you please call us so that we can insure that our records are correct.
Sincerely,
Dennis D. Davis, DDS