RicoLab Services Provider Questionnaire

Thank you for taking the time to complete the following questionnaire. This is the first step to engage us to provide your patients and your staff next level laboratory services.

A member of our team will review the information you have provided and follow up with you regarding next steps. Please feel free to call us at 813-419-2934 if you have any questions regarding the status of the request you've submitted.

Thank You!
RicoLab Services
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Email *
Please provide the name and address of your facility. *
Please provide the name, phone number and email address of the primary contact of your facility. *
What immediate need can we help you resolve? *
What coverage areas do you serve? (Where are your patients located) *
Are you currently working with a lab/collection service?
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If yes, what is the name of your lab/collection service?
What labs do you  work with or prefer to use for your patients?
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What insurance plans do you accept if any?
What patient population do you primarily service? *
What is your average number of collections or appointments per week?
If applicable, how many patients do you see within an hour?
What percentage % of your patients are self-pay for their lab work?
How soon would you like to start lab collection services? *
What's your billing preference? *
If you have any other needs, preferences, or comments, feel free to share them here!
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