Schedule Demo

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Wednesday, February 22, 2012

Schedule Demo

Company
- Leadership Team
  - Dustin Holt
  - Neil Skene
EHR 2012
Schedule Demo
EHR Industry
- Federal Requirements
  - Meaningful Use
  - Certification Standards
News Releases
Contact
Support

Ultra Media Gallery 8

Demonstration Form

Please help us tailor a demonstration to the needs of your practice by filling out this brief survey.

Last Name:

First Name:

Practice Name:

Street:

Unit:

City:

State:

Postal Code:

Telephone:

Email Address:

Request additional information?:
Yes
No

How did you hear about us?:

Do you currently have an EHR?:
Yes
No

If so, which one?:

How many doctors are in your practice?:

Do you have multiple locations?:
Yes
No

Will you want to track patients separately for each location?:
Yes
No

What is your billing software::
MediSoft
Other

Do you utilize a billing service?:
Yes
No

Is your practice multispecialty?:
Yes
No

What is/are your medical specialty(ies)?:

Are you currently using eRx?:
Yes
No

How many PAs's?:
Yes
No

How many office staff?:

Do you currently dictate?:
Yes
No

Do you receive more than $25,000 per year in Medicare?:

Are you looking for server-based or cloud-based?:
Server-Based
Cloud-Based

Preferred way of payment? (If purchased):
Paid in Full
Monthly Payments
Annual Subscription
Will Arrange Financing
Other

What concerns do you have about the MedAffinity EHR?:

Other comments to help us tailor a demo and save you time:

What are your main goals in your transition to EHR :
Save money on paper, filing, and storage
Save staff time
More professional time for patients
Reduce work after hours
Fewer claim denials
Better, more consistent documentation
Take advantage of federal stimulus rebates
Avoid federal penalties for lack of EHR

What concerns do you have for the transition to a new EHR?:

Clear / Reset

MedAffinity Corporation

1923B Capital Circle NE
Tallahassee, FL 32308
877.900.4EHR (4347)
info@medaffinity.com

"The more you know about EHR, the better we look."

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