Practice Consulting RFP

Practice Consulting - Request for Proposal 

Practice Name:

               

Physician Name(s):                  
Contact Name:    
Address:   
City:
State:
Zip:
Other Locations?
       
If yes, how many?
Distance from location listed above:  
Phone Number:
Fax Number:
Other Number:
E-Mail Address:
Specialty:
Number of Total Providers:

 MDs      

 DOs

 PAs

 NPs

How Did You Hear About Our Services?
(If you heard about us from another physician,
please let us know their name.)  
Are You a TMA Member?
       
Service Requested:    
Number and Positions of Key Staff:

 Full Time 

 Part Time

 Front Office

 Clinical Staff

 Office Managers

 Billing Staff

Practice Management Software:
Charts:
       
Billing:
       

 To Whom?

How do PAs or NPs Bill?
       
Please describe the main concerns of practice in detail:    
   
 Comments:  
   




   

 

 

 

 

 

 

 

  

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