Analysis Request

Patient Receivables Analysis Tool Questionnaire

Please complete the form to request an analysis

How much patient receivable revenue did you generate in the last three completed months?

How much of the revenue generated during those three months did you collect?

How much of the revenue generated during those three months do you have outstanding?

How many patient statements did you generate during the last three completed months?

How much did you spend on patient collections in the last three completed months? (Software, payroll, collection agency fees, postage, stationary, credit card processing, etc)

Name:
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Company Name:
Title:
Industry:
E-mail Address:
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Phone number:
Additional Comments: