Request an Insurance Receipt

Olo does not currently accept insurance, but as a courtesy to our patients, we can provide you with a receipt that you can submit to be reimbursed directly. This includes date(s) of treatment(s), amount paid, as well as diagnosis and treatment code.

Please note:
1. There is a $25.00 administrative for this additional service (it takes longer than you’d think)
2. It can take 1-2 weeks to be completed (though usually less)
3. WE CANNOT GUARANTEE THAT YOU WILL BE REIMBURSED

**Before you start this form please contact your insurance provider for a list of all the information you need from us. ***

Step 1 of 3 - General Information

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  • General Information