Medical Transport Data Request

We look forward to working with you.

Quick Med Claims is prepared to develop and submit a proposal to provide revenue cycle management (RCM) services to your organization. To aid us in developing a formal proposal, enter the provided password and complete the following medical transport information request form. Please supply us with the most recent data as it relates to the form below. Preferably, for the last full calendar year provided the organization has not had any significant changes in call volume or payor status since that time.

Please complete all sections that are applicable to your organization. If you need a password, have any questions, or require assistance, please contact Gary Harvat or Ed Marasco at (800) 901-1155.

The following content is restricted. Please enter the password to access the form.