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Hello and Welcome.

PLEASE NOTE: This section is for doctors only.

Are you thinking about becoming a client? If so, we are both at the start of something great. We look forward to working with you and we know you are going to like working with us. There are a couple of things we need from you to get started.  Please fill out the two forms below. 

The first form is an agreement that we will be paid on time (net 30 days). The second asks for office information and the best way to get in touch with you. These forms aren't 100% necessary to send us a case, but if we don't have them on file all cases will be C.O.D. and won't be sent back to you unless we receive payment in advance, which can delay the case from getting to you on time. 

Thank you in advance. Our doors are open and waiting for your first submission.

Confidential New Client Application

All new accounts are subject to C.O.D. or payment by Visa / MasterCard, American Express, or Discover prior to delivery until this form is submitted in full. Our terms are net 30 days. Accounts over 30 days delinquent are subject to a finance charge of 1.5% per month or 18% per annum. It is our policy to establish C.O.D. or prepayment terms while an account is in excess of 60 days.

I hereby agree to abide by the credit terms provided herein. I agree that in the event that collection of this account becomes necessary, I will pay the cost of collection as well as reasonable attorney fees incurred therefore.

Thanks for submitting!

Additional Information

Answers to the following questions are helpful in serving you better.  

Thanks for submitting!

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