Patient Notebook

TRUMPET BEHAVIORAL HEALTH LLC

390 Union Blvd

Suite 300

Lakewood, CO 80228

Phone: (855) 824 - 5669

Fax: (303) 984 - 4366

Email: FamilyAccounts@tbh.com

Website: www.tbh.com

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1. Patient Information

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Last Name *

Account Number

Dates of Service

Invoice Number

Email Address

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2. Payment Amount

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3. Payment Method

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P (855) 824 - 5669

F (303) 984 - 4366

W www.tbh.com

390 Union Blvd Suite 300

Lakewood, CO 80228