Home > MEDICAL / CHIROPRACTIC > Medical Forms > Encounter Forms / Superbills >

Custom Encounter Forms
Encounter Forms / Superbills
 
ACS Custom Encounter/Superbills; 9-1/2" x 11" Continuous Pin-feed, Perforated out to 8-1/2" x 11", 2-Parts. Customer to provide art work if available. If not send us your previous sample, sketch or typewritten draft and layout of what you want us to print we will do the rest. Make sure your codes are up-to-date and accurate.

9-1/2" x 11" Two Parts Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 2 part White 16# CB & Canary 15# CF
  • 9-1/2” x 11”
  • Your Choose of One Ink Color - Black, Brown, Burgundy, Green, Orange, Process Blue, Red, Reflex Blue
  • After Approved Proof Ships in 7 Working Days
  • Quantities Over 10,000 Ship In 10 Working Days
Add-Ons for Additional Charges
Numbering $55.00
Second Color $90.00
Print Back Copy Black Ink $90.00
3 Day Rush Orders Ships in 3 Days After Approved Proof $175.00

Email all Art to [email protected]
Mail to: ACS PO Box 5088 Georgetown, Texas 78627

Choose Your Options Below and Then Click Update Price to See Your Total Price.



Product Code: ES9.5-2

Choose Your Quantity

500 [Add $292.00]
1,000 [Add $320.00]
2,500 [Add $687.50]$275.00 per 1,000
5,000 [Add $975.00]$195.00 per 1,000
10,000 [Add $1,650.00]$165.00 per 1,000
20,000 [Add $2,780.00]$139.00 per 1,000
Choose Your Ink Color

Black
Brown
Burgundy
Green
Orange
Process Blue
Red
Reflex Blue
Add a Second Ink Color

No Second Color
Black [Add $90.00]
Brown [Add $90.00]
Burgundy [Add $90.00]
Orange [Add $90.00]
Process Blue [Add $90.00]
Red [Add $90.00]
Reflex Blue [Add $90.00]
Printing Back Copy One Color

No Back Copy
Print Back Copy Black Ink [Add $90.00]
Numbering

No Numbering
Numbering [Add $55.00]
Staring Number


3 Day Rush Order

No Need To Rush
3 Day Rush Order [Add $175.00]

Qty:  
Description Freight, Returns & Sales Tax Policies
 
ACS Custom Encounter/Superbills; 9-1/2" x 11" Continuous Pin-feed, Perforated out to 8-1/2" x 11", 2-Parts. Customer to provide art work if available. If not send us your previous sample, sketch or typewritten draft and layout of what you want us to print we will do the rest. Make sure your codes are up-to-date and accurate.

9-1/2" x 11" Two Parts Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 2 part White 16# CB & Canary 15# CF
  • 9-1/2” x 11”
  • Your Choose of One Ink Color - Black, Brown, Burgundy, Green, Orange, Process Blue, Red, Reflex Blue
  • After Approved Proof Ships in 7 Working Days
  • Quantities Over 10,000 Ship In 10 Working Days

Add-Ons for Additional Charges
Numbering $55.00
Second Color $90.00
Print Back Copy Black Ink $90.00
3 Day Rush Orders Ships in 3 Days After Approved Proof $175.00

Email all Art to [email protected]
Mail to: ACS PO Box 5088 Georgetown, Texas 78627

Products Frequently Bought Together
11 pt 2 Ply Color End Tab Folders 11 pt Manila 2 Ply End Tab Custom 8 Tab Poly Divider Set Times 2 Speed Cabinet
Your Price: $240.00

Add Free Shipping
Your Price: $48.95

Add
Your Price: $4.69

Add Free Shipping
Your Price: $4,500.00

Add
11pt Reinforced Solid Color End Tab Folders Sturdy Rigid 11 pt Manila 2 Ply End Tab Folder <!010>Custom 8  Tab Poly Divider Set Times 2 Speed Files
Heavy Duty Vinyl Stick-On Pockets 14 pt Manila 2 Ply End Tab TAB Match Year Label QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheet
Your Price: $55.95

Add Free Shipping
Your Price: $56.95

Add Free Shipping
Your Price: $13.95

Add
Your Price: $185.00

Add Free Shipping
Heavy Duty Vinyl Stick-On Pockets Heavy Duty 14 pt Manila 2 Ply End Tab Folder Year Label QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheet
Bilingual Privacy Patient Sign-In Month Label ALLERGY LABEL Outguides
Your Price: $85.95

Add Free Shipping
Your Price: $10.95

Add Free Shipping
Your Price: $10.95

Add Free Shipping
Your Price: $79.50

Add Free Shipping
Bilingual Privacy Patient Sign-In Month Label ALLERGY LABEL Outguides
Radiology Jacket Custom 6 Tab Divider Set Medi-Clip/Docu-Clip ACS Sliding Lateral Track
Your Price: $185.00

Add Free Shipping
Your Price: $2.43

Add Free Shipping
Your Price: $49.95

Add Free Shipping
Your Price: $6,500.00

Add Free Shipping
Radiology Jacket Non-Color Coded <!004>Custom 6 Tab Divider Set Docuclip  Fastener ACS Lateral Track Movable Shelving Systems
Poly Stick-On Pockets Custom 6 Tab Fileback Set Double Ply Top Tab Pocket Numeric Label
Your Price: $45.95

Add Free Shipping
Your Price: $3.18

Add Free Shipping
Your Price: $79.95

Add Free Shipping
Your Price: $22.95

Add Free Shipping
Poly Stick-On Pockets <!004>Custom 6 Tab Fileback Set Double Ply Top Tab Pocket Numeric Label
End Tab Expansion Pockets Alpha Label Barkley Match 36" Wide File Shelving
Your Price: $79.00

Add Free Shipping
Your Price: $13.95

Add
Your Price: $725.00

Add Free Shipping
<!001>End Tab Expansion Pockets Barkley FABKM Match 36 Single Entry Letter Size 4 Post Starter Unit

Share your knowledge of this product with other customers... Be the first to write a review

Browse for more products in the same category as this item:

MEDICAL / CHIROPRACTIC > Medical Forms > Encounter Forms / Superbills
MEDICAL / CHIROPRACTIC > Medical Forms
MEDICAL / CHIROPRACTIC


$9.95
$5.15
$12.95