Request a free quote.

1. Do you currently work with a medical billing service provider? *

Yes

No

2. How would you best describe your practice? *

Hospital Based

Primary Care

Specialty

Other

3. How many providers are in your practice? *

1 - 2

3 - 5

6 - 10

11 - 19

>20

6. Do you utilize a mobile charge capture product to capture hospital or dialysis charges? *

Yes

No

7. Do you utilize an electronic lockbox service for payments? *

Yes

No

Not sure

8.Total Monthly Collections - Combined Patient & Insurance *

<$50,000

$50,000 - $99,000

$100,000 - $199,000

$200,000 - $399,000

$400,000 - $599,000

$600,000 - $799,000

$800,000 - $999,000

>$1,000,000

Contact information *

Name

First Name

Last Name

Phone *

(###)

###

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