| 1) |
Are you primarily looking for EMR software, practice management software, medical billing software, or a medical billing service? [required] |
|
 |
EMR software (electronic medical records)
(you will be redirected to our EMR request page)
Practice management software
Medical billing software
A medical billing service
(you will be redirected to our medical billing services page)
|
| 2) |
For what type of practice/business are you looking to obtain medical software? [required] |
|
|
Physician office (family practice, medical clinic, etc.)
Medical billing service company
Hospital
Physical therapy practice (chiropractic office)
Psychologist practice (mental/behavioral health)
Dental practice
Medical equipment company (DME)
Other (please
specify):
|
| 3) |
Do you currently utilize a medical billing software solution? [required] |
|
|
No
- our practice/business does not currently use medical billing software
No
- this is for a new practice/business or office
Yes (please
indicate which solution, if known):
Not sure |
| 4) |
Which practice management functions are you looking to address with
this medical practice software solution? [required] |
|
|
Billing
and collections
Appointment
scheduling
Insurance
claim submission/management
Electronic
medical records (EMR)
Patient
records management
Reporting
Other (please
specify)
|
| 5) |
How many practitioners or billable providers will you be managing
with this medical software? [required] |
|
|
1-2
3-5
6-10
11-25
25+
|
| 6) |
How many individual office or business locations will be using your
medical practice software solution? [required] |
|
|
1
2
3-4
5+
|
| 7) |
Approximately how many users will need access to your medical billing
software solution? [required] |
|
|
1-2
3-5
6-10
11-25
25+
|
| 8) |
When would you like your medical billing software solution implemented? [required] |
|
|
Immediately
Within
two months
Between
two and four months
More
than four months
|
| 9) |
What is the five digit ZIP code for your office location? [required] |
|
|
Zip lookup for major cities
- Albuquerque, NM - Zip: 87199
- Arlington, TX - Zip: 76001 - 76019
- Atlanta, GA - Zip: 30301 - 31199
- Austin, TX - Zip: 73301 - 78799
- Baltimore, MD - Zip: 21075 - 21298
- Boston, MA - Zip: 02101 - 02297
- Charlotte, NC - Zip: 28201 - 28299
- Chicago, IL - Zip: 60601 - 60827
- Cleveland, OH - Zip: 44101 - 44199
- Colorado Springs, CO - Zip: 80901 - 80997
- Columbus, OH - Zip: 43085 - 43299
- Dallas, TX - Zip: 75201 - 75398
- Denver, CO - Zip: 80002 - 80299
- Detroit, MI - Zip: 48201 - 48288
- El Paso, TX - Zip: 79901 - 88595
- Fort Worth, TX - Zip: 76101 - 76199
- Fresno, CA - Zip: 93650 - 93888
- Honolulu, HI - Zip: 96801 - 96850
- Houston, TX - Zip: 77001 - 77299
- Indianapolis, IN - Zip: 46201 - 46298
- Jacksonville, FL - Zip: 32099 - 32290
- Kansas City, MO - Zip: 64101 - 64999
- Las Vegas, NV - Zip: 89044 - 89199
- Long Beach, CA - Zip: 90745 - 90899
- Los Angeles, CA - Zip: 90001 - 91335
- Louisville, KY - Zip: 40201 - 40299
- Memphis, TN - Zip: 37501 - 38197
- Mesa, AZ - Zip: 85201 - 85277
- Miami, FL - Zip: 33010 - 33299
- Milwaukee, WI - Zip: 53201 - 53295
- Minneapolis, MN - Zip: 55199 - 55488
- Nashville, TN - Zip: 37201 - 37250
- New Orleans, LA - Zip: 70112 - 70195
- New York, NY - Zip: 10001 - 10292
- Oakland, CA - Zip: 94601 - 94666
- Oklahoma City, OK - Zip: 73101 - 73199
- Omaha, NE - Zip: 68046 - 68198
- Philadelphia, PA - Zip: 19019 - 19255
- Phoenix, AZ - Zip: 85001 - 85099
- Portland, OR - Zip: 97200 - 97299
- Sacramento, CA - Zip: 94203 - 95899
- San Antonio, TX - Zip: 78201 - 78299
- San Diego, CA - Zip: 92101 - 92199
- San Francisco, CA - Zip: 94101 - 94199
- San Jose, CA - Zip: 95101 - 95196
- Seattle, WA - Zip: 98101 - 98199
- Tucson, AZ - Zip: 85701 - 85777
- Tulsa, OK - Zip: 74101 - 74194
- Virginia Beach, VA - Zip: 23450 - 23479
- Washington, DC - Zip: 20001 - 56920
NOTE: We only serve U.S. businesses at this time. |
| 10) |
What is your e-mail address? [required] |
|
|
Why we need your email address |
| 11) |
Other than price, what is most important to you when selecting a medical
practice management software solution? |
|
| |
Features
and functionality
Ease of use
Customization
Service
(installation, training and support)
Scalability
Other (please
specify):
|
| 12) |
Please briefly describe in detail any additional requirements you
have and the specific nature of your office or business. |
|
| |
Note: There is a 1,000 character limit for this answer. |
