Request for Service Quote

Wolfe Creek Holding LLC Mass Medical Billing Services Request for Service Quote.

Name Name First Last
Title
Phone Phone - ### - ### ####
FAX FAX - ### - ### ####
Email
Company Name
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
How many physicians in your practice?

How many physicians in your practice? 1-3 4-9 10-24 24-100 100+
Hospital Based or Office Based?

Hospital Based or Office Based? Hospital Office
What is your group's specialty?
What practice management system are you currently using?
Does your group currently use an outsourced billing service?

Does your group currently use an outsourced billing service? No Yes, Which one? Yes, Which one?
When did you implement your current practice management and billing system or service?

When did you implement your current practice management and billing system or service? Within the past 12 months 1-2 years 3-5 years over 5 years
What is your primary motivation for contacting us?

What is your primary motivation for contacting us? Increase your practice collection percentage Decrease cost of your collection process Speed up collection cycle Improve compliance Improve management reporting capabilities Other Other
How do you want us to contact you further?

How do you want us to contact you further? Call Mail Email
Additional Comments