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Patient Estimate Requests

To request an estimate of your out-of-pocket expenses for future services, please fill out the form below. A Valley Health representative will follow up with you by call or e-mail (according to your preference). Please keep in mind that this is an estimate and actual out of pocket expenses may vary as a result of the quality and accuracy of the information provided when making the request, the actual care provided at the time of service, and the level of coverage applied by your insurance (if any) when they process your claim.