Conference Form - JARALL Medical Management

SUBSCRIBE FOR A CHANCE TO WIN A PAIR OF AIRPODS

We will randomly select one lucky winner/submission

@ 12:00PM on Sunday September 15.

The winner will be alerted via email provided and must visit JARALL booth before conference end to pick up the prize.

Salutation

First Name

Last Name

Practice Name

Address

City

State

Zip Code

Phone Number

Preferred Method of Contact

Current EHR

Would you be interested in setting up a call to discuss outsourcing your billing?

Yes No

Do you currently outsource your billing?

Yes No