Please answer all these questions for us to give you a FREE quote.  Our office will contact you within 24 hours.  Thank you for your time. 

Click the submit button when you have completed this form.  In order to provide you with an accurate quote, please complete the following information.  If you indicate you would like to be contacted, we will contact you promptly.

Please provide the following contact information:  * Indicates Required Fields

First Name*             

Last Name*             

Title/Specialty*        

Organization          

Street Address*        

Address (Cont)       

City*                          

State/Province*       

Zip/Postal Code*    

Country                    

Work Phone*          

FAX*             

Email*                      

URL                           

What type of services are you looking for?   Full Practice Management Claims only Consulting Only Not Sure

What is your current billing set up?     In-House Billing Outsourced Billing New Practice

How many providers are in your office?  

Are you a Medicare Provider?      Yes     No

Are you a Medicaid Provider?    Yes  No

How are you filing your claim now?    On paper Electronic

How many claims are you filing per month? 

What is the average dollar amount per visit? 

Are you backlogged?    Yes     No

What percentage of claims are you getting rejected? 

How would you like us to contact you?   Email    Phone

Please answer all these questions for us to give you a FREE quote.  Our office will contact you within 24 hours.  Thank you for your time.  Click the submit button when you have completed this form.