Refer a Client, Get a Reward

You already know how MxSecure's medical transcription services can help simplify and streamline workflow, speed revenue cycles and generally make life easier for healthcare practitioners and their support staff. But what about your colleagues and their staff?

Don’t leave them in the dark – refer them to MxSecure! When they become a client, you'll receive $300 off your next invoice! It's a simple way to help out a colleague and reward yourself at the same time.

There’s no limit to the number of referrals you can make. Here's how:

• Simply fill out the form below to submit your referral
• A Regional Sales Manager will contact your colleague
• When your referral becomes a client, we’ll credit your account $300!
• Some restrictions apply

Refer a Colleague

Red* indicates a required field
Your Information:
Your Name*
Practice Name*
Phone*	(xxx) xxx-xxxx
Email*
Who are you referring?
Practice Name*
Contact Name*
Phone*	(xxx) xxx-xxxx
Street Address
City
State	Choose State -------------------------------------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Mass. Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hamp New Jersey New Mexico New York N. Carolina N. Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island S. Carolina S. Dakota Tennessee Texas Utah Vermont Virginia Washington Wash. DC W. Virginia Wisconsin Wyoming
Zip Code
Email*

Rules and Regulations:

• To receive the $300 credit to your account, the referral must become an invoiced client, completing 3,000 lines of transcription with MxSecure, Inc.
  
• Multiple referral forms for the same colleague will not be eligible for the $300 credit.
  
• Referral program is only available to current clients of MxSecure, Inc. In order to qualify as a current client, you must have transcribed 3,000 lines or more with MxSecure.