*Your Facility:

*Your Location:

*Contact Person:

*Your email address: (e.g.: you@aol.com)

*Estimated lines/minutes of dictation per month:

*Number of dictators:

*Will we be dialing into an existing digital system or would you like to use ours? (Note: Our system is accessed via an 800 number if long distance, the cost of which we absorb. If your facility has its own digital dictation system, we have the equipment and capability to access most every brand available.):

Your System
Our System

*Desired method of transfer (email, direct send and print, etc. Remember, not only can we transcribe and send your work to you, we can also remotely print it for you. Your staff will be required to keep paper in the printer and distribute your documents to their chart. There are no extra charges nor hidden costs for this service.):

Special Requests and Circumstances: Please use the box below for additional comments that will help us better understand your needs. You may enter up to 300 characters.