Physicians Name

Practice Name

Specialty

Practice Phone

 Practice Address

City, State

Zip

Email Address

How many active patients do you have?

How many patients do you see per day?

Average number of claims per month?

Average billed amount per claim?

What is the average hourly wage per employee?

Do you file claims electronically?

Do you experience a great number of rejections?

Do you currently have a backlog of claims?