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

Newsletter Sign-up Request

Today's Date

How did you hear about us?

Date you are available for a conference call: DATE

What TIME would you like us to reach you?

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