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Full Name :

Email :

Phone :

Practice :

Address :

Would you be interested in getting a quote to purchase an EMR?

Yes

Purchase Timeframe?

Immediate

3-6 Months

Interested in Free EMR and a Quote

Only interested in Free Version

If you are interested in only the Free Version, please skip all to the last

1) For what type of medical practice are you planning to obtain EMR software? [required]

Primary care

Specialty

Hospital

Dental

Physical therapy/chiropractic

Other (please specify):

2) How many licensed physicians will use this EMR system? [required]

1-2

3-5

6-10

11-25

25+

3) How many locations will use this EMR system? [required]

3-4

4)Which practice functions are you looking to address with EMR software? [required]

Record management and reporting

Interoperability with other medical practices/facilities

Automated prescription writing

Automated prompts/reminders

Electronic-tablet based charts

Other (please specify)

5) Other than price, what is most important to you when selecting medical software?

Features and functionality

Ease of use

Customization

Compatibility with palm handheld or PDA

Service (installation, training and support)

Other (please specify):

Please briefly describe any additional requirements you have for EMR software.

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Contact Info.

HEADQUARTERS
Email:	support@emdfix.com

Thanks for visiting the eMDfix web site. Balianti has created this web site to answer many of your most important questions about how eMDfix EMR systems can satisfy your requirements.

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