Select one of the options
below available for enrollment online.
View the links
to get more information about each option. Or
Sales for more information.
(Area +) Fax:*
Web Site URL:
Average Number of Patients Seen
Current Software System?
(if none, Leave Blank)
Number of Staff Physicians or Other Providers?
Would you be using the
Claim Submission Software?
(If you choose "help" we will send you more
information on our software).
Briefly Describe your goals for 1 Claim Source? How
Can we service the needs of your company? What are your major concerns with