Name *

First Name

Last Name

Phone *

(###)

###

####

Current Billing Method *

In-House

Outsourced

How satisfied are you with your current billing process? *

1 - Very Dissatisfied

2 - Dissatisfied

3 - Neutral

4 - Satisfied

5 - Very Satisfied

What challenges do you face with your current billing system? *

claim denials

delayed payments

compliance issues

Have you considered outsourcing your billing in the past? *

Yes

No