Sign up now, Synapse Medical Services Australia | Billing Services, Medical Transcription Services, Administration

1. I would like to sign up for these Synapse Medical Services:
Billing services
Transcription services

2. Providers full name as registered with Medicare Australia: *

3. Your ABN *

4. How do you wish to be known?
E.g. Dr J Smith, Consultant Neurologist – plus list professional qualifications to be added at the end of your name:

Title

First Name *

Last Name *

Medical Specialty

Qualifications

Date of Birth

5. Your contact details:

Work Address *

City *

State *

Postcode *

Country *

Work Phone Number *

Mobile Phone Number *

Work Fax Number

Email Address *

6. Your preferred log-in detail when using the Synapse website:

Username

Password

Confirm Password

7. Your banking details:

Financial institution name

Account Name

BSB Number

Account Number

8. Medicare Australia Online & Health Fund no-gap schemes:

Yes, I am currently registered for online claiming

Yes, I am currently registered with the health fund's simplified billings schemes

9. List your Private Practice(s) and Provider Number(s):

Primary Provider number

Primary Practice address

Telephone

Facsimile

Additional Provider number #1

Practice Address

Facsimile

Additional Provider number #2

Practice Address

Facsimile

Additional Provider number #3

Practice Address

Facsimile

10. Where did you hear about Synapse Medical Services?
Existing Synapse client
Website
At a conference
Search engine (e.g. Google)
Other

If a website or other source, please specify:

11. How would you prefer to be contacted?
Phone
Fax
Email
Dont mind

12. A one-off administration payment of $120 + GST ($132.00) is required to setup your account with Synapse Medical Services:

Please note that we offer a 30 day money back guarantee, with your payment being fully refundable after 30 days, if you are not completely satisfied with our services. Read more…

Name on Card *

Card Number *

Card Expiry *

Card Type *

CCV Number *

Amount * (a one-off payment of $132.00)

Yes, I would like to receive the periodic Synapse newsletter, for the latest updates

After you press the submit button, you will receive a few emails to confirm the above details, plus your successful credit card payment and tax receipt from Synapse Medical Services.

Thank you!

SIGN UP