Patient Information

  • Date Format: MM slash DD slash YYYY
  • Today's Payment

  • Insurance Information

  • I hereby authorize the direct payment of medical benefits to the Medi-Station for the activities of the employees. I understand that I am financially responsible for the balance not covered by insurance. I certify that all information is correct and authorize Medi-Station to release any information either medical attention or in the processing of requests for financial benefits.
  • Date Format: MM slash DD slash YYYY
Menu