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

Custom Encounter Forms
Encounter Forms / Superbills
 
Alternative Views:


ACS Custom Encounter/Superbills; 9-1/2" x 11" Continuous Pin-feed, Perforated out to 8-1/2" x 11", 3 - 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" Three Parts Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 3 part White 16# CB, Canary 15# CFB & Pink 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: ES9.5-3

Choose Your Quantity

500 [Add $360.00]
1,000 [Add $380.00]
2,500 [Add $787.50]$315.00 per 1,000
5,000 [Add $1,225.00]$245.00 per 1,000
10,000 [Add $1,950.00]$195.00 per 1,000
20,000 [Add $3,500.00]$175.00 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", 3 - 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" Three Parts Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 3 part White 16# CB, Canary 15# CFB & Pink 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
ACS Sliding Lateral Track 14 pt Manila 2 Ply End Tab Double Ply Top Tab Pocket Alpha Label Barkley Match
Your Price: $6,500.00

Add Free Shipping
Your Price: $56.95

Add Free Shipping
Your Price: $79.95

Add Free Shipping
Your Price: $13.95

Add
ACS Lateral Track Movable Shelving Systems Heavy Duty 14 pt Manila 2 Ply End Tab Folder Double Ply Top Tab Pocket Barkley FABKM Match
Radiology Jacket Numeric Label 11 pt Manila 2 Ply End Tab Heavy Duty Vinyl Stick-On Pockets
Your Price: $185.00

Add Free Shipping
Your Price: $22.95

Add Free Shipping
Your Price: $48.95

Add
Your Price: $55.95

Add Free Shipping
Radiology Jacket Non-Color Coded Numeric Label Sturdy Rigid 11 pt Manila 2 Ply End Tab Folder Heavy Duty Vinyl Stick-On Pockets
Custom 6 Tab Fileback Set 36" Wide File Shelving Month Label Medi-Clip/Docu-Clip
Your Price: $3.18

Add Free Shipping
Your Price: $725.00

Add Free Shipping
Your Price: $10.95

Add Free Shipping
Your Price: $49.95

Add Free Shipping
<!004>Custom 6 Tab Fileback Set 36 Single Entry Letter Size 4 Post Starter Unit Month Label Docuclip  Fastener
End Tab Expansion Pockets QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheet Times 2 Speed Cabinet Bilingual Privacy Patient Sign-In
Your Price: $79.00

Add Free Shipping
Your Price: $185.00

Add Free Shipping
Your Price: $4,500.00

Add
Your Price: $85.95

Add Free Shipping
<!001>End Tab Expansion Pockets QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheet Times 2 Speed Files Bilingual Privacy Patient Sign-In
Custom 8 Tab Poly Divider Set Custom 6 Tab Divider Set ALLERGY LABEL Poly Stick-On Pockets
Your Price: $4.69

Add Free Shipping
Your Price: $2.43

Add Free Shipping
Your Price: $10.95

Add Free Shipping
Your Price: $45.95

Add Free Shipping
<!010>Custom 8  Tab Poly Divider Set <!004>Custom 6 Tab Divider Set ALLERGY LABEL Poly Stick-On Pockets
TAB Match Year Label Outguides 11 pt 2 Ply Color End Tab Folders
Your Price: $13.95

Add
Your Price: $79.50

Add Free Shipping
Your Price: $240.00

Add Free Shipping
Year Label Outguides 11pt Reinforced Solid Color End Tab Folders

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


$835.00
$4,100.00
$85.00
$680.00