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Let ACS custom print your 
Custom Encounter/Superbills Forms
Available in Laser Cut Sheet
Snap Apart ( Carbonless ) and Continuous ( Pin-feed )

A professionally-designed encounter form is one of the most important communication tools a Medical Practice can use to reduce data entry and coding errors.  Custom printed encounter forms are cost-effective and help to produce a streamline patient billing process. Pre-printed encounter forms are up to 70% more cost effective when compared to an encounter form printed on blank paper.

Use Your Existing Design, or Create a New Personalized Form to Meet Your Facilities Needs. Choose Your Ink Color, we can match your current ink color.  Please send a sample of your existing form with order.  If changes are needed please mark clearly on sample provided and we will provide a proof to you for your approval before processing your order

Encounter Form Tips

• Making use of both the front and the back of the form allows
  extensive listing of codes.
• Initiate follow-up scheduling with a return appointment area.
• Use color and graphic effects to enhance your professional image.
• Print with one of our standard colors other than black or blue to clearly identify your manual entries on the form using a black or blue pen.

Laser Sheet
• Available in 1 part  
• numbeing Add $25.00 per 1000
• Printed in black ink
• 8-1-2" x 11"
• Blue or Black ink
• Other inks colors available on request
• Artwork provided from customer (useable email format, camera ready, or negative)
• Delivery - 7 days after returned approved proof.

Prices are per 1000 except 500 quantity is for lot.  Prices do not in include shipping.

Order Quantity	500/lot	1000	2,500	5,000	10,000
Laser Cut	$157.66	$94.91	$56.39	$43.84	$38.30
Laser Cut with Back Copy	$252.11	$141.92	$75.38	$53.89	$41.67

Carbonless Snap Apart Sets
• Available in 2 or 3 part sets, 
• numbering Add $25.00 per 1000
• Printed in black or blue ink
• 8-1-2" x 11"
• Blue or Black ink
• Other inks colors available on request
• Artwork provided from customer (useable email format, camera ready, or negative)
• Delivery - 7 days after returned approved proof.

 Prices are per 1000 except 500 quantity is for lot.  Prices do not in include shipping.

Order Quantity	500/lot	1000	2,500	5,000	10,000
2 Part	$402.82	$250.76	$153.81	$124.49	$102.51
2 Part with Back Copy	$486.02	$292.72	$170.42	$128.56	$106.87
3 Part	$522.02	$329.31	$224.87	$183.51	$151.07
3 Part with  Back Copy	$606.91	$370.85	$242.21	$186.03	$155.65

Carbonless Pin-Feed Forms
• Available in 1, 2 or 3 parts
• numbering Add $25.00 per 1000
• Printed in either blue or black ink
• 9-1-2" x 11"
• Blue or Black ink
• Other inks colors available on request
• Artwork provided from customer (useable email format, camera ready, or negative)
• Delivery - 7 days after returned approved proof.

Prices are per 1000 except 500 quantity is for lot.  Prices do not in include shipping.

Order Quantity	500/lot	1000	2,500	5,000	10,000
1 Part	$255.00	$140.00	$79.00	$69.00	$49.00
1 Part with Back Copy	$405.00	$216.00	$105.00	$79.00	$69.00
2 Part	$385.00	$238.00	$165.00	$135.00	$115.00
2 Part with  Back Copy	$540.00	$317.00	$185.00	$149.00	$125.00
3 Part	$499.00	$315.00	$215.00	$185.00	$155.00
3 Part  with Back Copy	$636.00	$395.00	$248.00	$195.00	$169.00