RPCES Certification
Application Form

Registered Patient Communication & Experience Specialist · Winter 2027 Cohort

Winter 2027 Cohort · Starts January 2027

8-Week Hybrid Program

RPCES Designation

Personal Information

Your full legal name and primary contact details.

First Name *

Last Name *

Email Address *

Phone Number *

Street Address

City

State

ZIP Code

Current Credentials / Certifications Held List all professional certifications or designations currently held.

Professional Background

Your current role, employer, and healthcare experience.

Current Job Title *

Organization / Employer *

Practice Setting *

Hospital / Health System Ambulatory Surgery Center (ASC) Medical Group / Physician Practice Community Health Center / FQHC Specialty Clinic Urgent Care Revenue Cycle / Billing Company Telehealth / Remote Services Other:

Role Category *

Scheduler Front-Desk Staff Patient Access Representative Referral Coordinator Call-Center Team Member Medical Assistant Healthcare Manager / Supervisor Revenue Cycle Staff Other:

Years of Healthcare Experience *

<1 yr 1–2 yrs 3–5 yrs 6–10 yrs 11–15 yrs 16+ yrs

Patient Interaction Frequency *

Daily — primary Several times/week Weekly Occasionally Minimal

Supervisor / Employer Information

Optional but recommended for employer-sponsored applications.

Supervisor / Manager Name

Supervisor Email

Is this enrollment employer-sponsored or reimbursed?

Yes — employer is sponsoring No — self-funded Pending employer approval

Program & Enrollment Preferences

Cohort availability and payment plan preference.

Cohort Availability *

Yes — fully committed to Winter 2027 Likely — pending work schedule confirmation Interested in a future cohort

Preferred Payment Plan *

Pay in Full — $797 · Best value, one-time secure Stripe payment Installment Plan — 3 × $279 · $837 total, spread across 3 months Small Team (3–5 staff) — $697/person · Save $100 per seat Large Team (6–10 staff) — $647/person · Save $150 per seat Enterprise (11+ staff) · Contact Healthcare Inspired for custom pricing

How Did You Hear About Us?

Email Newsletter Social Media Colleague / Referral HI Website Virtual Event / Webinar LinkedIn Search Engine Other:

Personal Statement

Required. Minimum 100 words recommended.

Why do you want to earn the RPCES certification? How will it impact your patients and organization? *

Additional Questions or Comments

Attestation & Signature

Please read carefully and sign below.

By signing below, I certify that all information provided in this application is true, accurate, and complete to the best of my knowledge. I understand that any misrepresentation may result in disqualification from the RPCES Certification Program.

I agree to the Terms & Conditions and Privacy Policy of Healthcare Inspired. I understand that submission of this application does not guarantee enrollment. A seat is only confirmed upon payment following onboarding approval. My secure Stripe payment link will be delivered privately to my email upon approval.

Applicant Signature *

Date *

How to Return This Application

Email: Scan or save as PDF and send to info@healthcareinspired.com with subject line: "RPCES Application – [Your Name]"
Online: Prefer to apply digitally? Use the faster online application form at healthcareinspired.com
Response Time: Applications are reviewed within 3–5 business days. Approved applicants receive a secure payment link via email.

RPCES CertificationApplication Form

RPCES Certification
Application Form