Insurance Navigation & Patient Advocacy Academy
Professional enrollment intake form for OHH Health Solutions. Complete the sections below to apply for the self-paced course and acknowledge the enrollment, payment, and policy terms.
Student Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City & State
Preferred Contact Method
Phone
Email
Text
Course Interest
All courses are pre-recorded and self-paced, allowing students to complete the training on their own schedule and at any time. Students will receive access to the course materials after payment has been received.
Which course/program are you interested in?
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Introduction to Medical Billing $350
All Things Medicare $125
Insurance Terminology $100
Understanding Prior Authorizations $275
Patient Advocacy Course $497
Full Insurance Navigation & Patient Advocacy Academy $750
Not Sure Yet
Why are you interested in this program?
What are your current career goals?
Do you currently work in healthcare?
Yes
No
Previously
If yes, briefly describe your experience:
Learning Expectations
Are you comfortable with self-paced online learning?
*
Yes
No
Do you understand this course is pre-recorded and not live instruction?
*
Yes
No
If additional 1-on-1 training or mentorship is requested, there is a separate fee of $175 per hour with a required minimum booking of 2 hours.
Are you interested in optional 1-on-1 coaching?
Yes
No
Maybe in the future
Course Policy Agreement
Policy Notice
Agreement Acknowledgments
*
I understand and agree to the no-refund policy.
I understand this is a self-paced pre-recorded course.
I understand optional 1-on-1 coaching is billed separately at $175/hour with a 2-hour minimum.
Policy Confirmation Signature
*
Electronic Signature
Full Legal Name
*
First Name
Middle Name
Last Name
Electronic Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
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