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Medical Coding Online Registration

Advanced Coding Services
Registration Form for
Professional Medical Coding Curriculum

Personal Information**Required Fields

**First Name
**Last Name

**Address (Line 1)

Address (Line 2)

**City
  
**State
  
**Zip Code

**Primary Phone Number
  
Alternate Phone Number
  

**Email


Education**Required Fields

**Are you 18 yrs or older or will be at start of class?
  

**Do you have high school diploma or GED?
Note: Students will need to provide proof of education at Orientation.
  

**Do you have a working knowledge of and are you comfortable with medical terminology and anatomy? How did you gain that knowledge?


Location and Payment**Required Fields

**Please select your desired Course Location (see locations below)


Flagstaff Location
Flagstaff Medical Center
1200 North Beaver Street
Medical Staff Conference Room-East Campus 3rd Floor
Flagstaff , AZ 86001-3198
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Phoenix Baptist Hospital Location
Phoenix Baptist Hospital
2000 W. Bethany Home Rd - West Auditorium
Phoenix, Arizona 85016
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St Joseph's Hospital Location
St Joseph's Hospital
McAuley Office Building
500 W Thomas
Suite 270
Phoenix, AZ 85013
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Total Cost $2200 (includes CPC exam): Class size is limited and is on a first come, first served basis. A $200 deposit with the registration is recommended in order to secure your place in the class of your choice. All students MUST attend orientation.

**Preferred Method of Payment
  
**Preferred Payment Amount
  

Comments

Note: Students are required to provide their own 2009: ICD-9, CPT and HCPCS manuals. Please plan on allowing approximately six to eight hours of home study time per week. For more information email or call Advanced Coding Services at dorie@advancedcodingservices.com or (928) 853-3465.
Online Enrollment

Step 1) Complete the Online Registration Form and click "Submit" at the bottom of the form.

Step 2) Once your form has been reviewed a representative of Advanced Coding Services will contact regarding your enrollment status and payment options.

Step 3) Make your minimum required Class Deposit ($200.00) to secure your enrollment in the class.


If you have any questions you can contact Advanced Coding Services at dorie@advancedcodingservices.com or 928-853-3465.

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