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Registration

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New Client Registration Form

Please complete a separate form for each clinician.

TITLE:

FIRST NAME:

LAST NAME:

Qualifications (e.g. MBBS FRACS):

ADDRESS:

POSTAL ADDRESS:

STATE:

POST CODE:

STATE:

POST CODE:

MOBILE / PHONE NUMBER:

FAX NUMBER:

PAGER:

ABN:

SPECIALITY:

Please indicate your number of :

CONSULTING SESSIONS PER WEEK:

OPERATING SESSIONS PER WEEK:

Banking Details for depositing of all Health Fund Payments:

PROVIDER LOCATION:

PROVIDER NUMBER:

Banking Details for depositing of all Health Fund Payments:

BANK NAME:

BRANCH NAME:

BANK ACCOUNT NUMBER:

BANK BSB:

MedicalBillingPlus strictly adheres to Australian Privacy Principles for storage and usage of collected data..

CLIENTS TESTIMONIALS

  • Working the Medical Billing Plus is the Best business decision I’ve made to date.

    .

  • Medical Billing Plus have turned my cash flow around money in my account fast. Thank you MBP

    .

  • Billing and Administrative tasks have not been my strength. I now no longer need to worry about this side of the business thanks to the team at Medical Billing Plus.

    .

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