Intro-enroll

CPC TRaining Course

Location		Class
LOS ANGELES		Course begins: January 22, 2011 Course ends: June 25, 2011 Time: 9 am to 3pm, Saturdays Location: The Coding Source, 3415 S. Sepulveda Blvd. Suite 901, Los Angeles, CA 90034

ANAHEIM		Course begins: January 22, 2011 Course ends: June 25, 2011 Time: 9 am to 3 pm, Saturdays Location: Kaiser Permanente Orange County, 441 N. Lakeview Ave., Anaheim, CA 92807

SAN DIEGO		Course begins: January 22, 2011 Course ends: June 25, 2011 Time: 9 am to 3 pm, Saturdays Location: TBA

PHOENIX, AZ		Course begins: January 22, 2011 Course ends: May 14, 2011 Time: 9 am to 3 pm, Saturdays Location: Residence Inn, 801 N. 44th St., Phoenix, AZ 85008

Personal Information

First Name *	Last Name *	Middle Name

Business or Cell Telephone format: xxx-xxx-xxxx	Home Telephone format: xxx-xxx-xxxx	Email *

Present Address *	City *

State *	Zip *

Education

School Name	No. of Years Completed	Degree or Diploma

Work Experience

1. Name of Employer	Duration of Employment

Type of Business

Your Title:

Miscellaneous

Rate your familiarity with medical terminology from 1 to 5: (5 being most familiar)

Do you have medical coding experience? *

Why do you wish to the take this medical coding training course? *

What are your employment goals? *

Where did you first hear about this course? *

Have you researched other courses in medical coding training? Please specify.

If you have any questions on The Coding Source Training Program or application, please contact Celsa Garcia, Program Coordinator, at 310.622.1001, ext. 213 or celsa@thecodingsource.com.