To help us better define your needs and give you pricing information, please take a few minutes and fill out this questionnaire.                                                            

Name:
Organization:
Email:
Phone:

Your reason for seeking pricing information:

You are doing comparative pricing with other services.

You are comparing an outsourcing solution with your in-house cost.

Other:

Please indicate the number of physicians or other health care professionals who will be using our dictation services:

Less than 5   6-10   11-15   16-20   Over 20

Type of facility:

Physician Practice    Hospital

Outpatient Clinic         Surgery Center

Other:

What is your current transcription turnaround time?

48 hours   36 hours   24 hours   < 24 hours

Other:

Describe your office computer setup (choose all that apply):

Networked PCs   Standalone PCs

Networked Printers   Standalone Printers

Macintosh   Terminals

Other:

Does your office have an Internet connection?

Yes    No

If yes, how are you connected to the Internet?

28.8 modem   33.6 modem   56K modem

ISDN   T-I/T-3 lines    ATM    Not sure

Please indicate what Word Processing software packages that are used in your office (choose all that apply):

MS Works    MS Word     97 WordPerfect

Word Star    Other:

Please add any additional comments or information:

The information you provide will be kept confidential and is strictly for Dearborn Medical Transcription internal use only.