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 Thank you for your interest in Avid's OneLook Anesthesia Billing and Practice Management Software. For further information on our products and services, please complete the form below.
        
          
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Contact Name
*:                                                  E-Mail*:
  
Practice Name
*:
                           Our Business is:                       Current Billing Performed by:
       
 Address
*:
                                       Current Billing Software:         Current Billing Service:
         
City*:                                ST*:         Zip*:
       
Phone
*:                               Fax:
        

 
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# of

Physicians                                                        
         Number of Billing Staff/Workstations:
CRNAs  Employed byGroup Hospital       Average Anesthesia Case Volume:      /
Residents                                                                    Average Pain Case Volume:                 /
Legal Entities/Groups we bill for                            Pain Cases are Primarily:

EDI Requirements:   I Prefer       Medicare Medicaid Blue Commercial 

 My Interests are:                 
OneLook Billing and Practice Management Software OnePay Program    
HIPAA Off-Site Backup Ad-Hoc Crystal Reports    Document Imaging       
Electronic Statements Demographic Downloads
Collection Interface

Other Information about your business you would like us to know:

Installation timeframe:                What Search Engine did you use:               What Search Terms did you use:
                                
 




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