Dermatology Billing

Contact Name First Last
Phone Number ### - ### - ####
Email
What is your position in the practice?
What is your preferred time for us to call?
Morning Afternoon Evening
Do you wish us to be discreet when calling?
Yes No
Practice Name
Practice Location

City, State
Number of Physicians?

MDs and DOs
Number of Non-Physician Providers?

PAs and NPs
Total Charges in previous 12 months?
Total Payments (receipts) in previous 12 months?
Approximately what percentage of the practice is Medicare patients?
Do you do Cosmetic Services?
Yes No
If Yes, approximately what percent of your revenue is based on Cosmetic Services?
Do you do Mohs Micrographic Surgery?

Yes No
Do you have an in-house Histology Lab?
Yes No
Are you currently using another billing service?
Yes No
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