Please complete the form below to get a FREE rate quote, which will include the FREE trial offer.  Rates are calculated based on turnaround, difficulty of medical specialty, equipment used, and volume.  Please provide as much information as possible to ensure an accurate quote.  You will receive your rate quote within 24 hours.

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Contact Name*

Practice or Physician Name and Address

Email*

Phone

Fax

What is your medical specialty?*

How many physicians/practitioners will use our service?*

How many patients are seen each week?*

Which dictating system would you like to use?*
 Phone-in Dictating System Digital Recorder Cassette Tapes Other
Specify if other:

How would you like to receive your finished documents?
 Secure FTP Fax Delivery (Flint and surrounding area) Other
Specify if other:

What is the turnaround time you expect?*
 12 hours 24 hours 24-48 hours 48-72 hours

How soon would you like to implement our service?*
 Immediately Within 2 weeks Within 1 month 1 to 2 months

Please describe any additional requirements or details