Billing Application - Patient Stream

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Start Adding 30% To Your Clinic’s Revenue

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33%

Name(Required)

First Last

Phone(Required)

Email(Required)

Clinic Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Insurance Carrier(s)(Required)

Medicare

Cigna

HMO

WC

Aetna

BCBS

PI

First Choice

VA

Other

Are You In Network?(Required)

In Network

Other

What Software Do You Use For Billing(Required)

Name Of Primary Front Desk Staff

First Last

Name Of Office Manager

First Last

Name Of Case Manager

First Last

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