Please complete the form below to download "The Patient Financing Compliance Checklist".

First Name

Last Name

Email

Company

Are you looking to add Patient Financing in the next 12-18 months? Yes No Maybe

Will you require an RFP/ RFQ? Yes No

Do you currently use a patient financing solution? Yes No

If so, who?

What is your biggest concern for adding Patient Financing? Recourse Cost Time to Implement Patient Satisfaction Other

If other, what concerns do you have in adding a Patent Financing Solution?

What type of patient financing are you interested in? Recourse Non-Recourse Both I'm Not Sure

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