Paid Claims- DR. Amin

Payment Authorization
I authorize ITHRIVE Health LLC and or Gregory Rainbolt to initiate either an electronic debit or to create and process a demand draft against my bank account for each Bio Scan checked below. I acknowledge that the origination of ACH transactions to my account must comply with the provisioning of United States law. *

I agree to the terms and conditions: X
Physician
Bank Account *
Business Name on the Check *
Exactly as it appears on the check.
Full Name on the Check *

Prefix First Name Middle Name Last Name Suffix
Murlidhar A. Amin, MD, PA

2300 HWY 365, Ste. 150

Nederland, Texas 77627
Date / Time *

Month Day Year
at
Hour Minutes AM/PM Option Date Picker Icon
Name
Signature *

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Bio Scans Reimbursed

Please check each scan once you have received reimbursement from the insurance provider.
Jan 2017 Paid Claims
Feb 2017 Amin Paid Claims
Mar 2017 Amin Paid Claims
April 2017 Amin Paid Claims
May 2017 Amin Paid Claims
June 2017 Amin Paid Claims
July 2017 Amin Paid Claims
Aug 2017 Amin Paid Claims
Sept 2017 Amin Paid Claim
Oct 2017 Amin Paid Claim
Nov 2017 Amin Paid Claims
Dec 2017 Amin Paid Claims
Jan 2018 Amin Paid Claims
Feb 2018 Amin Paid Claims
Mar 2018 Amin Paid Claims
April 2018 Amin Paid Claims
May 2018 Amin Paid Claims
June 2018 Amin Paid Claims
July 2018 Amin Paid Claims
Aug 2018 Amin Paid Claims
SEPT 2018 Amin Paid Claims
Oct 2018 Amin Paid Claims
Nov 2018 Amin Paid Claims
Dec 2018 Amin Paid Claims
Jan 2019 AMIN Paid Claims
Feb 2019 AMIN Paid Claims
March 2019 Paid Claims
April 2019 Paid Claims
May 2019 Amin Paid Claims
June 2019 Amin Paid Claims
July 2019 Amin Paid Claims
ITHRIVE Health LLC.

Screenings@ITHRIVEhealth.com

888.982.8539
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Payment Authorization

Physician

Murlidhar A. Amin, MD, PA

Bio Scans Reimbursed