New Client Conference Call and Quote Request
Thank you for contacting us. We would like to setup a conference call to discuss your situation. To make the most of the call and for us to be able to provide you with a quote for service, please provide us with the information requested. Thank you again. We will respond within 24 hours. We are looking forward to hearing from you.
First Name
Last Name
Phone number
Practice Name
office address
office website
email
Newsletter Sign-up Request
Opt me in
Opt me out
Today's Date
How did you hear about us?
Google
article
Dental Town
Dentistry Today
Website
Dental Show
Linkedin
Existing Client
Vendor
Past Client
Date you are available for a conference call: DATE
What TIME would you like us to reach you?
8am
8:30am
9am
9:30am
10am
10:30am
11am
11:30am
12noon
12:30am
1pm
1:30pm
2pm
2:30pm
3pm
3:30pm
4pm
4:30pm
5pm
5:30pm
6pm
6:30pm
7pm
7:30pm
What Dental Software do you use?
How many days is your practice open?
What is the average number of claims submitted per month?
What is the total $ in accounts receivable over 30 days aging?
How can we help you? Let us know your concerns and any other questions that will help us prepare for our meeting. Please include which services you are interested in: claims management, patient balances management, EOB/ETF entry, benefits verification, hygiene reactivation, medical billing for dental procedures, training and/or consulting.
Send me a copy of my responses
Email address
Privacy Policy
|
Report Abuse
Your submission is being processed. Please do not close this browser window until complete.
