Getting Started

Please complete the form below so we can learn more about your practice and your specific needs. One of our sales representatives will contact you soon to see if our services are a good match for your practice.

First Name

Last Name

Practice Name

Email address

Street Address

City

State

Zip Code

Website

Type of Practice

Number of Practitioners

When giving the information for volume and income, please only consider claim and income for which you will want us to do billing. Also note that the income figures are for amount you receive (on average), not the amount you bill out.

Approximate Number of Claims Billed Out Per Week

Average Amount That You Receive (not billed) Per Claim

How Did You Hear About Us?

I’d Like to Start on

Currently My Billing is Handled By

Do You Have and Comments or Questions?

Ready to learn more?

Contact us for your complimentary consultation.