Medical Pro Contact

Medical Professional
Quick Quote Or Consultation

QUICK QUOTE OR CONSULT FORM
Name of Medical Practice
Name of Contact *
Contact Phone Number *
Contact Email Address *
Specialty *
State Business is Located In *
BEST TIME TO CALL *

Early Morning Mid Morning Late Morning/Early Afternoon Late Afternoon Evening
If issue is related to specific insurance company, please list insurance name and state located in
Looking for Consult in regards to *

Audits Credentialing Benefits Claims Coding Starting a new practice Something Else
Please briefly describe concern (please do not include any HIPAA covered or confidential details) *
Please choose your service *
30 minute consultation $ 100.00 USD
60 minute consultation $ 200.00 USD
ONCE OUR OFFICE RECEIVES YOUR REQUEST, YOU WILL BE CONTACTED WITHIN 48 BUSINESS HOURS TO SET UP A CONSULT TIME THAT WORKS BEST WITH YOUR SCHEDULE.
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