Practice Information

Practice Name *

Type of Practice *

General Practice

Dentistry

Physical Therapy

Others

If others, please specify:

Number of Employees: *

Location (City, State, Country): *

Phone *

Email *

Practice Needs

What specific tasks would you like your Medical VA to handle? (Select all that apply) *

Appointment Scheduling & Reminders

Medical Billing & Insurance Verification

Medical Transcription & Documentation

Patient Record Management

Coordination with Labs/Pharmacies

Follow-up Communications with Patients

Other

If other, please specify below: *

Do you currently have any systems in place for patient records, scheduling, etc.? (Please describe briefly) *

Privacy & Compliance Requirements

Are you familiar with HIPAA regulations? *

Yes

Do you require your Medical VA to undergo additional training to meet specific compliance needs? *

Yes

What specific compliance standards does your practice require? (e.g., HIPAA, local regulations, etc.) *

VA Preferences

Do you prefer a Medical VA with specific experience? (e.g., experience with a particular software, specialty in certain areas, etc.) *

What hours would you like your VA to be available? *

Full-time

Part-time

Flexible/On-demand

Additional Information

What are your main goals or challenges for streamlining your practice with a Medical VA? (e.g., increasing efficiency, improving patient care, reducing overhead costs, etc.) *

Do you have any additional requests or concerns regarding the Medical VA service? (Please provide details): *

Once we receive your form, we will contact you to discuss your needs in detail and provide recommendations for the best Medical VA solution tailored to your practice.