Reimbursement Assessment Please complete the form below to determine whether or not there is a potential opportunity for Healthcents to obtain new and more profitable contracts for your practice or company. You will be notified at the email in the form below, immediately, based upon your answers. * = Required Field Size of your company or practice*1 to 5 people are employed by my company or practice6 to 10 people are employed by my company or practice11 to 20 people are employed by my company or practiceMore than 20 people are employed by my company or practiceCurrent Reimbursement as a percentage of Medicare (if applicable)<70 percent of Medicare>=70 percent of Medicare and <=100 percent of Medicare>100 percent of Medicare and <=140 percent of Medicare>140 percent of Medicare and <=150 percent of Medicare>150 percent of Medicare and <=200 percent of Medicare>200 percent of MedicareDo you have a competitive advantage such as unique services and or products?*YesNoWhat are your payer contracting goals? (e.g., get into new payer networks, re-negotiate payer contracts etc.)*Name* First Last Job TitleCompany or Practice Name*State / State(s) you do business in*Email* Phone*Check to box below to indicate you are a real person enrolling and that this is not a computer generated request. Thank you.