Software implementation: Getting to Know You

The information in this form is confidential and may be legally privileged. It is intended solely for the addressee(s). Access to this e-mail by anyone else is unauthorized.

Conversion Information:

Please fill in the information below and submit before the planning call!

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Primary Office Contact

First person we will try to contact if there are questions during the implementation.

Secondary Office Contact

If primary contact cannot be reached, especially after business hours

IT Contact

This person takes care of your computers

Number of Team Members That Will Be Using the Software

Current Computer and Software Information

Software/Program and Practice Information

Conversion Customization Options

If you do not want these options, please mark "No"

HIPAA Check

Please provide the names of two active patients in your database. This will be used to verify the validity of your database after the conversion.

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