Please correct the errors described below.

Burgess Pediatrics, Inc.
401 Burgess Drive, Suite C,
Menlo Park, CA 94025-3408

For contract/billing questions contact
Leigh Phillips at
or call (650) 305 2039

By choosing to use a credit card instead of bank debit via ACH, I accept a 3% credit card surcharge on each payment.

End billing when:
30 days after patient provides written cancellation

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