Online Estimate Information

If you would like information on our services, please fill out this form. When you have completed it, press the "send" button. A representative from our staff will contact you. There is no obligation on your part. A bold field name indicates required information.

Name
Organization
E-mail
Phone
Fax
Address 1
Address 2

City                       State:         Zip:

If your organzation has a web page, please enter the URL below:

http://www.

Facility type:	Doctor Office (single) Doctor Office (Group) Clinic Hospital Surgery Center Other

If facility type is "other", please describe below:

How many dictators do you currently have?

Please list your specialties:

Approximately how many lines of transcribed documents do you currently create on a daily basis?

If the answer to the above question is unknown, about how many hours of dictation per day do you create?

Do you have in-house transcriptionists?

	Yes No

How much of your dictation do you plan to outsource?

	Less than 20% 20% to 40% 40% to 60% 60% to 80% Over 80%

Do you wish temporary scheduled backlog coverage, or permanent scheduled coverage?

	Temporary Permanent

Do you currently have a backlog?

	Yes No

If yes, how large?

What is your required turn around time by work type?

Have you used an outside transcription service previously?

	Yes No

How are your dictators currently dictating?

	Hand Held Tapes Digital Hand Helds Digital Dictation System (over the phone) Internet Based Dictation System Other

If method of dictation is "other", please describe below:

If you have a digital dictation system, what is the brand and model?

If you are using digital hand helds, what is the brand and model?

If you are using an internet-based dictation system, who is your ASP?

How do you want your reports returned?

	Electronic Hard Copy

Do you have an electronic patient charting system that we would need to import our reports into?

	Yes No

If yes, what kind?

If you would like an electronic copy and do not have an electronic patient charting system, in what word processor would you like the reports returned? Please be specific.

Please provide samples and format guidelines. (Please remove all patient identifiers, then cut and paste the text in the box below - holds up to 10,000 characters.)