STAT SHEET
Please fill out form completely.
Month & Year |
NEW PATIENTS |
ADJUSTMENTS |
COLLECTIONS |
SERVICES |
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DC'S NAME: |
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PHONE#: |
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FAX#: |
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What are your goals for this year? Please state: |
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Complete & fax to (410) 272-7549
(The column marked Services would show the difference
in what you collect at the time of the adjustment.
Example: If you charge $23 for the adjustment and had 890 adjustments
in the month, then you should have collected $20,470 in that month.)
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© 2007 Sigafoose Seminars All Rights Reserved. |