Douglasville Medicine Associates
	5076 Brand Blvd., Suite 401
	Douglasville, NY  01234
	Ph: (123) 456-7890
	 Fax: (123) 456-7891
	Email: admin@dfma.com
	Website: www.dfma.com
EVAN LAGASSE	Date:	6/21/2012
208 Jackman Lane	Account No:	LAG001
Compton, NY  01255	Student No:	Student1
SUBJECT:  SERVICE DATE 11/21/2008 – BALANCE DUE $208.00
Dear Mr. Lagasse:
I am writing you today since our repeated requests for payment have been ignored. According to our records your balance remains unpaid to our practice. We have not received a response despite attempts to reach you to set up a payment plan, and my instructions to my staff to make every effort available to satisfy any misunderstanding you may have concerning your new balance.
I am deliberately withholding any action on your account for the next ten days. If we do not receive any response from you I will be forced to turn your account over to our collection agency, Northern Recovery Services Incorporated.
We understand that many of our patients experience financial difficulties. If this is the case please do not hesitate to contact me at the office.
Sincerely Yours,
Jackie Simmons, CMA
Office Manager
Your initials
This project was funded at $3,000,000 (100% of its total cost) from a grant awarded under the Trade Adjustment Assistance Community College and Career Training Grants, as implemented by the U.S. Department of Labor’s Employment and Training Administration. Rogue Community College is an equal opportunity employer/program. Auxiliary aids and services, alternate form and language services are available to individuals with disabilities and limited English proficiency free of cost upon request.      

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