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Contact Information
Contact Title
Contact Names (First Last)
*
Contact Phone
*
Contact Email
*
City:
Province/State
Business Information
Professional/Business Name:
Medical specialty
Website
How did you learn about us?
*
Specification
How many locations do you have?
*
How many healthcare providers do you have in total?
*
Average monthly number of scheduled appointments
Need online appointment scheduling
*
Yes
No
I am not sure
Need automated phone scheduling (virtual receptionist)
*
Yes
No
I am not sure
Need phone (voice) appointment reminders
*
Yes
No
I am not sure
Need SMS (text) appointment reminders
*
Yes
No
I am not sure
Need email appointment reminders
*
Yes
No
I am not sure
Need custom online forms
*
Yes
No
I am not sure
Need synchronization with existing EMR or scheduling software
*
Yes
No
I am not sure
Name and version (if any) of your existing EMR or scheduling software
Additional requirements