CAP Request


	Famous Quotes
	" We are very happy with PTC. " Leandra Lynch MD COLORADO

Physicians Total Care
5415 S. 125th Avenue
Suite 205
Tulsa, Oklahoma 74146

800.759.3650

918.254.6182 fax

	Clinic Contact Information
Clinic Name:
Contact Person:
Contact Title:
Clinic Address:
City:
State:
Zip:
Phone Number:		Fax Number:
email Address:
	Clinic Statistics
# of Doctors:		# of separate sites:
# Patients per doctor per day:

% patients with no prescription:		% patients with 1 prescription:
% patients with 2 or more prescriptions:		Average number of refills per prescription:
Payers:	% Cash & Carry
	% Private Insurance
	% HMO/PPO
	% Worker's Compensation
	% Medicare
	% Others
List Clinic Specialties:
10 most common drugs w/ strength and count:
6 most common 3rd party payors with percentage of patients with each:
Comments:
Where did you hear of PTC:
	After clicking submit you should see a "Thank You" screen. If not, please try again.



	What is the earning potential in my practice? Click here to find out.

}