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

Patient Encounter Form
Patient Encounter / Superbill Form


 
FREE SHIPPING!
Buy 3 packs of this Item and get FREE SHIPPING!
Less than 3 packs Flat Shipping Rate $15.95
List Price: $165.00
Your Price: $145.00
You Save $20.00!
Setup Cost: $0.00
Unit Qty: 500
Unit: pack
Overall Dimensions: 8 1/2 x 5 1/2"


Product Code: 860-3-DFS

Custom Optional Print

Fill In Optional Imprint:


Custom Print

Fill In Your Imprint Information:




Qty:  
Description Freight, Returns & Sales Tax Policies
 
Patient Encounter Form Pre-printed with your information, includes blank spaces to add your own Diagnostic Codes.

  • Snap Apart Form - Glued Top
  • Printed in Black Ink3 Parts - White, Canary & Pink
  • 8-1/2" x 5 1/2"
  • 500 per pack
  • Personalization includes- Includes your imprinted practice name, address, and phone number, up to 5 lines. 3-part form provides a patient copy and a 2-hole punched permanent record.

Products Frequently Bought Together
Numeric Label Radiology Jacket 14 pt Manila 2 Ply End Tab Poly Stick-On Pockets
Your Price: $19.95

Add
Your Price: $85.00

Add
Your Price: $45.95

Add
Your Price: $24.00

Add
Numeric Label Radiology Jacket Non-Color Coded Heavy Duty 14 pt Manila 2 Ply End Tab Folder Poly Stick-On Pockets
Alpha Label Barkley Match Month Label Times 2 Speed Cabinet Double Ply Top Tab Pocket
Your Price: $12.95

Add
Your Price: $10.95

Add
Your Price: $4,500.00

Add
Your Price: $59.50

Add
Barkley FABKM Match Month Label Times 2 Speed Files Double Ply Top Tab Pocket
End Tab Expansion Pockets Custom 6 Tab Divider Set Custom 6 Tab Fileback Set ACS Sliding Lateral Track
Your Price: $79.00

Add
Your Price: $2.10

Add
Your Price: $3.18

Add
Your Price: $6,500.00

Add
<!001>End Tab Expansion Pockets <!004>Custom 6 Tab Divider Set <!004>Custom 6 Tab Fileback Set ACS Lateral Track Movable Shelving Systems
Medi-Clip/Docu-Clip ALLERGY LABEL Custom 8 Tab Poly Divider Set 11 pt Manila 2 Ply End Tab
Your Price: $42.50

Add
Your Price: $10.95

Add
Your Price: $4.69

Add
Your Price: $42.95

Add
Docuclip  Fastener ALLERGY LABEL <!010>Custom 8  Tab Poly Divider Set Sturdy Rigid 11 pt Manila 2 Ply End Tab Folder
11 pt 2 Ply Color End Tab Folders 36" Wide File Shelving ACS QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheets (package of 600) Bilingual Privacy Patient Sign-In
Your Price: $235.00

Add
Your Price: $725.00

Add
Your Price: $175.00

Add
Your Price: $66.95

Add
11pt Reinforced Solid Color End Tab Folders 36 Single Entry Letter Size 4 Post Starter Unit ACS QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheets (package of 600) Bilingual Privacy Patient Sign-In
Heavy Duty Vinyl Stick-On Pockets TAB Match Year Label Outguides
Your Price: $36.00

Add
Your Price: $13.95

Add
Your Price: $79.50

Add
Heavy Duty Vinyl Stick-On Pockets Year Label Outguides

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
DENTAL > Dental Forms > Encounter Forms
VETERINARY > Forms, Checks and Letterhead > Encounter / Supebills Forms
MEDICAL / CHIROPRACTIC > Medical Forms
DENTAL > Dental Forms
VETERINARY > Forms, Checks and Letterhead