KW Advanced Consulting CPC / CPB / CRC / CPMA one-on-one Tutoring Registration Form.
Demographic Information (Required)
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
AAPC ID# (if none leave blank)
Email
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example@example.com
Credential(s) pursuing
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CPC
CPB
CRC
CPMA
Exam Status
Have you taken the CPC / CPB / CRC / CPMA exam already?
Please Select
No, first attempt
Yes – 1 attempt
Yes – multiple attempts
If you answered "Yes" to the previous question, please upload the break down of your AAPC test score for each section. (This can be found by going to your exam section on AAPC select the "score" and you will see the break down for each section).
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If you answered "No" the previous question, please tell us your area of concern.
Please Select
ICD-10-CM
CPT
HCPCS
Modifiers
Guidelines
Medical Terminology
Anatomy & Physiology
Risk Adjustment (CRC)
Compliance / Auditing (CPMA)
Time management during the exam
Test anxiety
Describe your biggest challenges in your own words
Target exam date (if scheduled)
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Availability & Scheduling
Time Zone
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Eastern
Central
Mountain
Pacific
Other
Preferred tutoring days
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Mon
Tue
Wed
Thu
Fri
Sat
Preferred time blocks
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Morning
Afternoon
Evening
Terms & Conditions
Tutoring Package Selection
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Basic 2.0
Advanced 2.0
Pro 2.0
Signature
Date Signed
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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