Please provide the following contact information:

Contact Person
Title
Practice Name
Street Address
Address (cont.)
City
State/
Zip Code
Work Phone
FAX
E-mail

What is your practice specialty?
 

How many office locations do you have?
 

How many providers are in your office?
 

How is your current billing being done? (check all that apply)

In House
Paper claims
Electronic Claims
Outsourced

Approximately how many patients does your office see per day?
 

Are you interested in computerized scheduling?
Yes    No

Select any of the following services you are interested in:

Claims Only Billing          
Old A/R Clean-Up             
Full Practice Management     
Follow-up Only             
Credentialing                
Claims Billing & Follow-up   
Verification of Benefits     
Mental Health Transcription

What are some of your main problems or concerns with your
current billing and or mental health transcription?