Your Name:
Your E-mail:
Name of your package
Package Components
Accounting / Billing Only
Clinical Use Only
Both Accounting and Clinical
Other purpose
If other purpose, please name
Web Address ?
Contact Name
Contact Email Address
Which system does your package operate under? (Multiple answers allowed)
To select more than one answer
on the Macintosh make your selections using Cmd -
click (ie click while holding the "apple" key.
on Windows, make multiple selctions by holding the
Control key while clicking.
Please select -
Macintosh
Windows based PC
DOS based PC
Unix
Linux
What functions does your package provide? (Multiple answers allowed)
To select more than one answer
on the Macintosh make your selections using Cmd -
click (ie click while holding the Apple key.
on Windows, make multiple selctions by holding the
Control key while clicking.
Appointments
Billing
Recalls
HIC Medclaims
Waiting Room Times
Prescriptions
Referral Letters
Pathology Downloads
Patient Health Summaries
Networked
Full Consultation Records
CPI Handouts
Patient Education
Travel Information