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Pink Billing Solution Superbill
Billing Agreement
Patient Demographic form
W-9 Fillable Form
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INTAKE FORM - NUE CONCEAL
Artist Name
Name of business
Email
Phone
Proof of insurance
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NPI number
Proof of tattoo license or some other form of proof that you are practicing legally in your state
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Banking information
Bank Name
Routing Number
Account Number
Signed Agreement
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How did you hear about us?
Receipt of $100 payment to Pink Billing Solutions for annual fee
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W-9 Fillable Form
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