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Let ACS custom print your
Custom Encounter/Superbills Forms
Available in Laser Cut Sheet
Snap Apart ( Carbonless ) and Continuous ( Pin-feed )

A professionally-designed encounter form is one of the most important communication tools a Medical Practice can use to reduce data entry and coding errors. Custom printed encounter forms are cost-effective and help to produce a streamline patient billing process. Pre-printed encounter forms are up to 70% more cost effective when compared to an encounter form printed on blank paper.

Use Your Existing Design, or Create a New Personalized Form to Meet Your Facilities Needs. Choose Your Ink Color, we can match your current ink color. Please send a sample of your existing form with order. If changes are needed please mark clearly on sample provided and we will provide a proof to you for your approval before processing your order

Encounter Form Tips

* Making use of both the front and the back of the form allows
extensive listing of codes.
* Initiate follow-up scheduling with a return appointment area.
* Use color and graphic effects to enhance your professional image.
* Print with one of our standard colors other than black or blue to clearly identify your manual entries on the form using a black or blue pen.

Laser Sheet
• Available in 1 part
• numbeing Add $25.00 per 1000
• Printed in black ink
• 8-1-2" x 11"
• Blue or Black ink
• Other inks colors available on request
• Artwork provided from customer (useable email format, camera ready, or negative)
• Delivery - 7 days after returned approved proof.

Prices are per 1000 except 500 quantity is for lot. Prices do not in include shipping.

Order Quantity

500/lot

1000

2,500

5,000

10,000

Laser Cut

$157.66

$94.91

$56.39

$43.84

$38.30

Laser Cut with Back Copy

$252.11

$141.92

$75.38

$53.89

$41.67


Carbonless Snap Apart Sets
• Available in 2 or 3 part sets,
• numbering Add $25.00 per 1000
• Printed in black or blue ink
• 8-1-2" x 11"
• Blue or Black ink
• Other inks colors available on request
• Artwork provided from customer (useable email format, camera ready, or negative)
• Delivery - 7 days after returned approved proof.

Prices are per 1000 except 500 quantity is for lot. Prices do not in include shipping.

Order Quantity

500/lot

1000

2,500

5,000

10,000

Part

$402.82

$250.76

$153.81

$124.49

$102.51

2 Part with Back Copy

$486.02

$292.72

$170.42

$128.56

$106.87

3 Part

$522.02

$329.31

$224.87

$183.51

$151.07

3 Part with Back Copy

$606.91

$370.85

$242.21

$186.03

$155.65



Carbonless Pin-Feed Forms
• Available in 1, 2 or 3 parts
• numbering Add $25.00 per 1000
• Printed in either blue or black ink
• 9-1-2" x 11"
• Blue or Black ink
• Other inks colors available on request
• Artwork provided from customer (useable email format, camera ready, or negative)
• Delivery - 7 days after returned approved proof.

Prices are per 1000 except 500 quantity is for lot. Prices do not in include shipping.

Order Quantity

500/lot

1000

2,500

5,000

10,000

1 Part

$255.00

$140.00

$79.00

$69.00

$49.00

1 Part with Back Copy

$405.00

$216.00

$105.00

$79.00

$69.00

2 Part

$385.00

$238.00

$165.00

$135.00

$115.00

2 Part with Back Copy

$540.00

$317.00

$185.00

$149.00

$125.00

3 Part

$499.00

$315.00

$215.00

$185.00

$155.00

3 Part with Back Copy

$636.00

$395.00

$248.00

$195.00

$169.00

Prices do not include shipping charges.


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Patient Encounter / Superbill Form Patient Encounter Form

FREE SHIPPING / Snap Apart Form / 3 Parts / Add Your Facility Name & Address / 8 1/2 x 5 1/2"  / 500 per pack

List Price: $165.00
Your Price: $145.00
You Save $20.00!
Setup Cost: $0.00