Rate Enhanced Billing

Thank you for participating in our Enhanced Billing Conversion Project. Please complete the following information to assist us in your transition. Please reach out to your PointClickCare Account Manager with any questions or concerns regarding this opportunity.

Org Code*

Client Name*

Who is your Account Manager?*

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Please identify your preference for roll-out the Rate Enhanced Billing*

ie. Single facility, multiple facilities - phased approach, big bang.

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If you are planning on rolling out in phases, please describe or list the facilites for each phase

If you are undecided at this time, please indicate. This can be reviewed with either your Account Manager or Project Manager

Do you have a preferred go-live date?

At least 2 contact persons are required for Rate enhanced Billing conversion, please provide contact name and email address*

First contact name

First client email address*

Second contact name

Second client email address

Are you a current SmartPath customer (Yes/No)

Select or enter value

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