Form Page | LeadPilot

Practice Name *

Contact Name *

Email address *

Phone Number *

How many providers work at your practice *

Less than 3
3 to 5
6 to 10
11 to 25
More than 25

Which Services do you need? *

Medical Billing Services
Credentialing Services
Both

What is your specialty? *

Addiction Treatment Services / Center
Allergy and Immunology
Alternative & Holistic Medicine
Anesthesiology
Applied Behavior Analysis / Autism
Bariatrics / Obesity
Cardiology
Chiropractic
Community Health Center / FQHC
Dentistry
Dermatology
Diagnostic Radiology
Dialysis Clinic
Emergency Medicine
Endocrinology
Family Medicine
Gastroenterology
General Practice
Hospital
IVF / Fertility Clinics
Infectious Disease
Internal Medicine
Medical Genetics
Mental & Behavioral Health
Multi-Specialty
Nephrology
Neurology
Nuclear Medicine
Obstetrics and Gynecology
Occupational Therapy
Oncology / Hematology
Ophthalmology
Optometry
Orthopedics / Sports Medicine
Otolaryngology (ENT)
Pain Management
Pathology
Pediatrics
Physical Medicine & Rehabilitation
Physical Therapy
Plastic & Reconstructive Surgery
Podiatry
Proctology
Psychology
Psychiatry
Pulmonology
Radiation Oncology
Rheumatology
Sleep Medicine / Center
Speech Therapy
Substance Use Recovery
Surgery
Urology
Other Specialty

What is your approximate monthly collections revenue *

Under $25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+

Timeline *

Looking immediately
Within 30 days
Within 90 days
Just researching options

Current billing arrangement *

In-house
Outsourced
Hybrid

EMR /Practice Management system *

Pain Points *

High A/R
Staffing Shortages
Slow Payments
Credentialing issues
Authorization issues
Looking to switch billing companies

Zip Code *

Comment

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