Home > MEDICAL / CHIROPRACTIC > Medical Forms > Encounter Forms / Superbills >

Custom Encounter Forms
Encounter Forms / Superbills
 
Alternative Views:


ACS Custom Encounter/Superbills; 9-1/2" x 11" Continuous Pin-feed, Perforated out to 8-1/2" x 11", 3 - Parts. Customer to provide art work if available. If not send us your previous sample, sketch or typewritten draft and layout of what you want us to print we will do the rest. Make sure your codes are up-to-date and accurate.

9-1/2" x 11" Three Parts Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 3 part White 16# CB, Canary 15# CFB & Pink 15# CF
  • 9-1/2” x 11”
  • Your Choose of One Ink Color - Black, Brown, Burgundy, Green, Orange, Process Blue, Red, Reflex Blue
  • After Approved Proof Ships in 7 Working Days
  • Quantities Over 10,000 Ship In 10 Working Days

Add-Ons for Additional Charges
Numbering $55.00
Second Color $90.00
Print Back Copy Black Ink $90.00
3 Day Rush Orders Ships in 3 Days After Approved Proof $175.00

Email all Art to [email protected]
Mail to: ACS PO Box 5088 Georgetown, Texas 78627

Choose Your Options Below and Then Click Update Price to See Your Total Price.



Product Code: ES9.5-3

Choose Your Quantity

500 [Add $360.00]
1,000 [Add $380.00]
2,500 [Add $787.50]$315.00 per 1,000
5,000 [Add $1,225.00]$245.00 per 1,000
10,000 [Add $1,950.00]$195.00 per 1,000
20,000 [Add $3,500.00]$175.00 per 1,000
Choose Your Ink Color

Black
Brown
Burgundy
Green
Orange
Process Blue
Red
Reflex Blue
Add a Second Ink Color

No Second Color
Black [Add $90.00]
Brown [Add $90.00]
Burgundy [Add $90.00]
Orange [Add $90.00]
Process Blue [Add $90.00]
Red [Add $90.00]
Reflex Blue [Add $90.00]
Printing Back Copy One Color

No Back Copy
Print Back Copy Black Ink [Add $90.00]
Numbering

No Numbering
Numbering [Add $55.00]
Staring Number


3 Day Rush Order

No Need To Rush
3 Day Rush Order [Add $175.00]

Qty:  
Description Freight, Returns & Sales Tax Policies
 
ACS Custom Encounter/Superbills; 9-1/2" x 11" Continuous Pin-feed, Perforated out to 8-1/2" x 11", 3 - Parts. Customer to provide art work if available. If not send us your previous sample, sketch or typewritten draft and layout of what you want us to print we will do the rest. Make sure your codes are up-to-date and accurate.

9-1/2" x 11" Three Parts Pinfeed Includes
  • Custom Print Front
  • Forms are printed with your choice of codes, descriptions and formats.
  • Continuous
  • 3 part White 16# CB, Canary 15# CFB & Pink 15# CF
  • 9-1/2” x 11”
  • Your Choose of One Ink Color - Black, Brown, Burgundy, Green, Orange, Process Blue, Red, Reflex Blue
  • After Approved Proof Ships in 7 Working Days
  • Quantities Over 10,000 Ship In 10 Working Days

Add-Ons for Additional Charges
Numbering $55.00
Second Color $90.00
Print Back Copy Black Ink $90.00
3 Day Rush Orders Ships in 3 Days After Approved Proof $175.00

Email all Art to [email protected]
Mail to: ACS PO Box 5088 Georgetown, Texas 78627

Products Frequently Bought Together
11 pt 2 Ply Color End Tab Folders 14 pt Manila 2 Ply End Tab Bilingual Privacy Patient Sign-In Alpha Label Barkley Match
Your Price: $235.00

Add Free Shipping
Your Price: $45.95

Add Free Shipping
Your Price: $66.95

Add Free Shipping
Your Price: $12.95

Add
11pt Reinforced Solid Color End Tab Folders Heavy Duty 14 pt Manila 2 Ply End Tab Folder Bilingual Privacy Patient Sign-In Barkley FABKM Match
11 pt Manila 2 Ply End Tab TAB Match Year Label Double Ply Top Tab Pocket Outguides
Your Price: $42.95

Add
Your Price: $13.95

Add
Your Price: $79.95

Add Free Shipping
Your Price: $79.50

Add Free Shipping
Sturdy Rigid 11 pt Manila 2 Ply End Tab Folder Year Label Double Ply Top Tab Pocket Outguides
Poly Stick-On Pockets ALLERGY LABEL Custom 6 Tab Divider Set Custom 8 Tab Poly Divider Set
Your Price: $24.00

Add Free Shipping
Your Price: $10.95

Add Free Shipping
Your Price: $2.10

Add Free Shipping
Your Price: $4.69

Add Free Shipping
Poly Stick-On Pockets ALLERGY LABEL <!004>Custom 6 Tab Divider Set <!010>Custom 8  Tab Poly Divider Set
36" Wide File Shelving End Tab Expansion Pockets Times 2 Speed Cabinet ACS Sliding Lateral Track
Your Price: $725.00

Add Free Shipping
Your Price: $79.00

Add Free Shipping
Your Price: $4,500.00

Add
Your Price: $6,500.00

Add Free Shipping
36 Single Entry Letter Size 4 Post Starter Unit <!001>End Tab Expansion Pockets Times 2 Speed Files ACS Lateral Track Movable Shelving Systems
Heavy Duty Vinyl Stick-On Pockets Medi-Clip/Docu-Clip Custom 6 Tab Fileback Set Numeric Label
Your Price: $36.00

Add Free Shipping
Your Price: $42.50

Add Free Shipping
Your Price: $3.18

Add Free Shipping
Your Price: $19.95

Add Free Shipping
Heavy Duty Vinyl Stick-On Pockets Docuclip  Fastener <!004>Custom 6 Tab Fileback Set Numeric Label
ACS QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheets (package of 600) Radiology Jacket Month Label
Your Price: $175.00

Add Free Shipping
Your Price: $85.00

Add Free Shipping
Your Price: $10.95

Add Free Shipping
ACS QuickStrip File Folder Labels, 6-up on 8.5 x 11 Sheets (package of 600) Radiology Jacket Non-Color Coded Month Label

Share your knowledge of this product with other customers... Be the first to write a review

Browse for more products in the same category as this item:

MEDICAL / CHIROPRACTIC > Medical Forms > Encounter Forms / Superbills
MEDICAL / CHIROPRACTIC > Medical Forms
MEDICAL / CHIROPRACTIC