Cole Medical For Internal Use OnlyRequest To Transfer Account to Collections "*" indicates required fields Your Name*Select your nameAnnaBarbaraBrianCandiceCherylChristineDanielleDawnDonnaDoreenEnzaJeanetteJenniferJohianaJudyKellyLauraLeanneLeighLindaMerrylMirnaShawnVirginiaProvider/GroupPatient Account #'s*ie: 123, 142, 164, 421 (separate by comma)NotesCAPTCHA Δ