Referral Rewards Application

Referral Rewards Application

To refer a client or colleague to TruCode and participate in our Referral Rewards program, please complete the form below. For more information on this program, please click here.

Referring Customer*

Referring Customer Email Address*

Name of hospital/health system you are referring*

City*	State*

Hospital/health system primary contact*

Primary contact title*

Primary contact email address*	Primary contact phone number*

Current HIS System*	Current Encoder*

Please provide some background information (Dissatisfaction with current vendor, seeking cost savings, etc.):