Request a Receipt

Requests for receipts must be submitted in writing via this form. Either print and fax this form or fill in and submit the form online via the web. Requests cannot be fulfilled via the telephone.

During peak time periods such as near tax time it may take 48 hours or longer to process the receipt request.

All receipts will be emailed using the email address provided.

  • Only enter the last four digits of your social security number
  • This field is for validation purposes and should be left unchanged.

American Board of Psychiatry and Neurology, Inc.

2150 E. Lake Cook Road, Suite 900, Buffalo Grove, IL 60089

Phone 847.229.6500 | Fax 847.229.6600