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