Intake form

Name *

Email address *

What is your organization's primary focus?

Please select at least one option.

Hospital

Physician Group

Outpatient Clinic

Long-term Care

Home Health

What is the size of your organization?

Which EMR system does your organization currently use?

What accounting system does your organization currently utilize?

What specific challenges are you facing with revenue recognition?

How did you hear about TLC revenue?

Please select at least one option.

Referral

Online Search

Social Media

Conference

What is your preferred method of communication?

Additional questions or comments

TLC Revenue