Liberty Medical Billing


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Please complete the following page and a billing specialist from Liberty Medical Billing will contact you shortly. Fields in Bold are required

First Name
Last Name
Contact Person
Office Address
City
State
Zip Code
Work Phone
Fax
Email Address
Practice specialty
Number of office locations
Number of providers
How is your current billing being done? (check all that apply)



How many patients do you see in an average day?
What types of services are you interested in?
Briefly describe some of your main problems or concerns with
your current billing:
When and how would you like our billing
specialist to contact you?
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