Product Evaluation Form

HealthCare Synergy

Product Evaluation Form

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Contact Information

First and Last Name


Email Address

Would you like to be included in our mailing list?YesNo

How did you hear about HealthCare Synergy?WebsiteMailer/BrochureEmailPrint/AdvertisementWorkshop/Trade ShowReferralOther

Agency Information

Agency Name

Agency Address

City, State, Zip

Office Phone

Is the agency Medicare Certified?YesNo

Current Patient Census:

Number of software users?


Back Office

Products and Services you would like to evaluate:

SoftwareHAS-WE (Web Edition)SITCdeVero

Managed ServicesCoding OnlyCoding and OASISAnalytics - Clinical/FinancialChart ReviewADR ReviewPre-Claim ReviewPPS BillingRevenue RecoveryBookkeeping and/or Accounting

Cost Reporting
Simeone ConsultingManis & Ryan


HHG: Buddy and Best BuddySHP

Other Tools
Backup ServicesEligibility AssistantAbility

Additional Information

Thank you for your interest! A HealthCare Synergy representative will get back to you within the next 24 hours.