Synergy Medical Information Systems - Information Request - Synergy Healthcare Resources, billing business, medical billing, medical billing business, medical billing home business, medical billers, healthcare industry, medical billing software, medical billing at home business, medical billing center, at home business

Please complete the following form and we will provide you with access to additional information on establishing your own medical billing home business! Please take note that starting a medical billing home business does require a monetary investment, and this is not a free offer. If you have any questions, please contact our Sales Department at 800-652-3500 extension 2 - or email our sales department at sales@synergymis.com.

If we are unable to contact you, or if the information is not valid, we will not send you our FREE Information.

We look forward to working with those who are seriously considering beginning their own medical billing business. In order for us to do our job effectively, we must be able to contact you.

Those items listed with a * below are required fields.

* Name:
* Address:
* City/State:
* Zip Code:
* Business Phone:
Other Number:
* E-mail:

What would be the most convenient time to contact you? (CST)	Between and
How did you hear about Synergy MIS?
If you chose "Other Referral" above, please describe:
Are you currently working with, or have you been referred here by one of our Synergy Billing Center Consultants? If so, please select them from the following list:
If you chose "other" above, please tell us who:
How soon will you be starting your business?
Do you request that a Synergy MIS Billing Center Consultant contact you immediately?
Have you already viewed our information or used our software demo?
Why are you interested in the medical billing industry?
Questions or Comments:

Practice Manager® X3 | Synergy Healthcare Resources | Synergy Franchise Corp.

Copyright © Synergy Medical Information Systems
Synergy Medical Information Systems
1150 Eastport Drive • Suite C1 • Valparaiso, IN 46383
(800) 652-3500 • Fax: (219) 531-7540

Sign-up for our FREE e-mail newsletter to receive notification of specials and promotions.

Click here to review our complete Privacy Statement.