Know the Risks. Grow Your Practice.

How to fill out the Reimbursement Analysis Form

We are pleased that you have decided to work with our consultant to take a closer look at your clinic’s fees. In order to efficiently and effectively assist you, the consultant needs to know the fees you are currently charging for certain codes and what your reimbursement rates are from the insurance carriers with whom you have agreements.

Simply download the form, insert your fees for all fields, save your completed form, and email it to

The quicker we get this completed form, the sooner we can get your clinic started on your journey to greater compliance and growth.

For assistance filling out this form, please watch the video below. (4m:35s)