Custom Insurance Assignment Release Slips, 4" x 5-1/2", 100 Sheets per Pad
$9.29
5-9 pad
(
$0.09/EACH
)
Custom Insurance Assignment Release Slips, 4" x 5-1/2", 100 Sheets per Pad
Item #:
901-QFN142231R
Model #:
7QGFM142231R
Brand:
Quill Custom Print
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Product details
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- Patient insurance coverage forms
- 4" W x 5-1/2" L
- White 20# text stock; printed in black ink
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$9.29
5-9 pad
(
$0.09/EACH
)
100 EACH = 1 PAD
Custom Insurance Assignment Release Slips, 4" x 5-1/2", 100 Sheets per Pad
Buy more & save!
Extra 50% off on 40+ units
Qty. savings
Per pad
22%
$7.29
10 - 19 pad
31%
$6.39
20 - 29 pad
38%
$5.79
30 - 39 pad
50%
$4.69
40 + pad
Frequently bought together
Item #: 901-QFN142231R
$9.29
5-9 pad
($0.09/EACH)
50% off
$4.69
40+ pad
($0.05/EACH)
$46.45
+
Item #: 901-QFW2054101
$18.99
1 pack
($0.08/EACH)
22% off
$14.79
20+ pack
($0.06/EACH)
$18.99
Total
$65.44
Description
Form specifies patient insurance coverage and authorizes assignment of payment to your practice.
- Patient insurance coverage forms
- 4" W x 5-1/2" L
- White 20# text stock; printed in black ink
- 100 sheets per pad, order in quantities of 5 pads
- Padded at the top
Specifications
# Up Per Sheet/Page
1
Binding Type
Padded
Brand
Quill Custom Print
Carbonless
No
Color
White
Customizable
Yes
Form Size
4" x 5-1/2"
Form Type
Insurance
Format
Medical Authorization Form
Holes Punched
No
Lines
7
Media Quantity
100
NCR Paper
No
Number of Parts
1
Numbered
No
Package Quantity
100 per Pad
Personalization
Yes
Security Features
No
Sheet Size
4" x 5-1/2"
