Training Request

Practice / Contact Information
Practice Name*
Contact Name*
Contact Phone*
Contact Email*

Participants
Below, please add additional participant(s) for your training session. We will try our best to accomodate.

Scheduling
Below, please select the preferred time for your training session. We will try our best to accomodate.
Note: The actual date for the training will be coordinated as part of our follow-up

Training Type
Type of Training Required (check all that apply)*

Claims (Electronic Submission, ERAs, E-Statements)EligibilityBilling (Claims Entry, Fee Schedules, Procedure Codes, etc.)Electronic PrescribingEHR

Training Type/Format
Type/Format of Training and Pricing*

Remote -- $300-- 3 hours, computer-based

Confirmation
By checking Agree, I confirm my request for training from Criterions and understand this will take 24 to 48 hours to process*

Agree
Initials*
From Name
Submission Date

YearMonthDay
Form Email
Email Subject
Form Date
Click Submit to complete enrollment or click Previous to update/add information.
Should be Empty: