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", 1-Part. 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" One Part Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 1 part White 20# bond
  • 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: ES9.5-1

Choose Your Quantity

500 [Add $215.00]
1,000 [Add $245.00]
2,500 [Add $437.50]$175.00 per 1,000
5,000 [Add $725.00]$145.00 per 1,000
10,000 [Add $1,150.00]$115.00 per 1,000
20,000 [Add $1,900.00]$95.00 per 1,000
Choose Your Ink Color
Click to view another Choose Printing 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", 1-Part. 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" One Part Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 1 part White 20# bond
  • 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
Heavy Duty Vinyl Stick-On Pockets Radiology Jacket Medi-Clip/Docu-Clip 14 pt Manila 2 Ply End Tab
Your Price: $55.95

Add Free Shipping
Your Price: $185.00

Add Free Shipping
Your Price: $49.95

Add Free Shipping
Your Price: $56.95

Add Free Shipping
Heavy Duty Vinyl Stick-On Pockets Radiology Jacket Non-Color Coded Docuclip  Fastener Heavy Duty 14 pt Manila 2 Ply End Tab Folder
Bilingual Privacy Patient Sign-In ACS Sliding Lateral Track Double Ply Top Tab Pocket End Tab Expansion Pockets
Your Price: $85.95

Add Free Shipping
Your Price: $6,500.00

Add Free Shipping
Your Price: $79.95

Add Free Shipping
Your Price: $79.00

Add Free Shipping
Bilingual Privacy Patient Sign-In ACS Lateral Track Movable Shelving Systems Double Ply Top Tab Pocket <!001>End Tab Expansion Pockets
Numeric Label TAB Match Year Label 36" Wide File Shelving Custom 8 Tab Poly Divider Set
Your Price: $22.95

Add Free Shipping
Your Price: $13.95

Add
Your Price: $725.00

Add Free Shipping
Your Price: $4.69

Add Free Shipping
Numeric Label Year Label 36 Single Entry Letter Size 4 Post Starter Unit <!010>Custom 8  Tab Poly Divider Set
Poly Stick-On Pockets Custom 6 Tab Fileback Set 11 pt Manila 2 Ply End Tab Outguides
Your Price: $45.95

Add Free Shipping
Your Price: $3.18

Add Free Shipping
Your Price: $48.95

Add
Your Price: $79.50

Add Free Shipping
Poly Stick-On Pockets <!004>Custom 6 Tab Fileback Set Sturdy Rigid 11 pt Manila 2 Ply End Tab Folder Outguides
QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheet ALLERGY LABEL Custom 6 Tab Divider Set Times 2 Speed Cabinet
Your Price: $185.00

Add Free Shipping
Your Price: $10.95

Add Free Shipping
Your Price: $2.43

Add Free Shipping
Your Price: $4,500.00

Add
QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheet ALLERGY LABEL <!004>Custom 6 Tab Divider Set Times 2 Speed Files
Alpha Label Barkley Match 11 pt 2 Ply Color End Tab Folders Month Label
Your Price: $13.95

Add
Your Price: $240.00

Add Free Shipping
Your Price: $10.95

Add Free Shipping
Barkley FABKM Match 11pt Reinforced Solid Color End Tab Folders Month Label

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


$5.35
$170.00
$11.95
$12.70