Request for a Quote - HIPAA Services
To request a quote for HIPAA Services, please fill out this form
Email address *
Official Name of the Covered Entity *
E.g., Dental Practice of Dr. John Smith, DMD
Your answer
Primary Location of the Covered Entity *
Enter the physical address, e.g, 1234 Main Street, City, State, Zipcode
Your answer
Total Number of Office Locations *
Enter the number of office locations that are used by the covered entity. E.g., 1.
Your answer
Contact Full Name *
First Name, MI, Last Name
Your answer
Contact Phone Number *
Your answer
Current website
Enter the URL of your current website (if available)
Your answer
Total Number of Staff Members *
Enter total number of providers, practitioners & supporting staff (e.g., receptionists etc.)
Your answer
Number of Phone Lines Required *
E.g., primary office line, emergency after hours line.
Your answer
Total Number of Workstations *
Enter total number of desktops & laptops that will be used by the covered entity
Your answer
Terms of Use | Privacy Policy *
Required
A copy of your responses will be emailed to the address you provided.
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