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Intake form
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Name
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Email address
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What type of processing services do you require?
Please select at least one option.
1095 A form processing
1095 B form processing
1095 C form processing
Consultation services
What is your preferred method of communication?
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Email
Phone
Video Conference
Please indicate your familiarity with the 1095 forms.
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Not familiar at all
Somewhat familiar
Very familiar
Expert
What is your business type?
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Individual
Small Business
Corporation
Non-Profit
What is your timeline for completion of these services?
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Immediate
Within a week
Within a month
Flexible
Do you require any additional services?
Please select at least one option.
Document storage
Consultation on healthcare options
Tax advice
How did you hear about us?
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Search Engine
Social Media
Referral
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Which service or services are you interested in?
Please select at least one option.
1095 A data verification
Passport documentation
Tax Ein or business documents
Health, Life,Accidental,ICU or dental insurance.
Initial consultation for $150
Follow-up consultation for $100
Additional questions or comments
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