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TRAINING AGREEMENT
Company Name: Rep:
Address:
Suite#:
City:
 State: Zip: Phone:
Contact: Market: Start Date:
 

Patients’ Choice Network will provide its members with a comprehensive, six-month training course on how to effectively and efficiently process Workers’ Compensation cases — from start to finish!

The program includes:
Hands-on training and certification on ACOEM Guidelines and the AMA Guides to the Evaluation of Permanent Impairment; access to ACOEM-compliant reporting software, practical solutions for structuring practices and getting paid on new cases; valuable industry updates (including case laws); rules that allow patients to choose their doctors; rules that mandate quicker payments to physicians with appropriate case structuring; and other sessions & workshops as outlined in PCN’s Training Curriculum.

TRAINING FEE

  
TOTAL RATE:    
CONTRACT TERM:                               
6 Months   
Start up fee:                                               
Net Purchase:                                           
TOTAL CASH DOWN:                          
(includes $ for last month security deposit)
 
TOTAL BALANCE DUE:                      
Monthly payment of:                                          
First payment due on the 20th of:   

NOTICE: This document constitutes a written agreement between you and Patients’ Choice Network (PCN). By signing and dating this agreement, you represent that you have had the opportunity to read this agreement, acknowledge that you are in receipt of a copy and agree to each and all of the provisions and conditions thereof. If PCN accepts this Agreement, you will become a PCN member having access to the Network, its affiliates and its services, under its policies, terms and conditions.

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