Global Integrated Reimbursement Services Inc.

DOC Fix Bill Update
November, 2010

REIMBURSEMENT REQUEST FORM

Please fill out the form below and send us your contact information and special request. We look forward to serving you!

The fields labeled (*) are required

* Your Email Address

* Name (First and Last)

* Company Name

Address

City

State

Zip Code

* Your Phone Number

* Your Extension

Reason for Contacting Us:

Coding Application	Medical Technology Hotlines
Health Economics and Market Access	Payer Policy Research and Support
Reimbursement Assessment	Other

Additional Comments or Requests

5100 Poplar Ave., Suite 2700 Memphis, TN 38137
(P) 1-901-322-6018 (F) 1-901-339-4840 / 1-901-752-0238
info@girsinc.com

Additional Resources: