Business Consulting Services Inquiry
Name
First Name
Last Name
What type of services are you interested in?
*
Business Startup/Formation
Virtual Business Setup
Business Planning
Strategic Planning
Website Creation
Logo Design
Program Development
CARF Consulting
Preferred method of payment for consulting services:
*
Card (fees apply)
Cash
Electronic Check (fees apply)
AfterPay Installments (fees apply)
CashApp
Zelle
Existing Legal Company Name or Desired Startup Name
*
Physical Address of Company or Home Address (if home based business)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Check here if:
Mailing Address Same as Physical Address
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
# of Locations
Addresses of additional locations (if applicable)
Hours of Operation
Business Phone Number
*
-
Area Code
Phone Number
Fax Number
-
Area Code
Phone Number
Cell / Alternate Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Business Website and/or Social Media Handles
Owner/CEO Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
What services/products do you offer?
What EHR Software are you currently using? (Healthcare Only)
Are you satisfied with it?
Yes
No
N/A
Is the organization accredited in any way?
Yes
No
Applied and Scheduled
N/A
What accrediting organization was chosen?
If applicable, when does the accreditation expire?
Have you ever outsourced your billing before?
Yes
No
How many times per week are you currently billing?
What kind of billing issues are you having, if any?
How many clients/patients do you have?
*
How many providers do you have?
How many locations do you have?
Tax ID
NPI
CAQH
Medicaid Provider #
Other Business Identifiers/Licenses
What insurance companies are you credentialed with?
To help us get to know your organization...
Upload a brochure or any marketing material describing your services.
Browse Files
Preferably PDF format
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of
Describe the structure of your organization.
How else can we help you?
Are there any additional services you may be interested in?
Management
Training
CPR
Credentialing
Admin Services
Any services not listed that you may need assistance with?
What are your expectations of our services?
Enter the message as it's shown
*
Email
example@example.com
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