Overview Demonstration Step-by-Step More Info Clinical Background

EnterVue© Initial Questionaire

If you would like to have a representative from EnterVue© contact you, please fill out the top part of this form labeled "General Information". Optionally, you may include your question and/or comments. When finished, click the "Submit" button at the bottom of the web page.

If you would like to learn how EnterVue© can fit within yor office or clinic, please complete as much of the form as you can.

This information is strictly for internal use and will not be released to any party outside our organization.
 

General Information
Full Name:
Email Address:
Phone:
Organization:
Street1:
Street2:
City:
State:   Zip
General Questions or Comments:   
 
Office Specification		  
Average number of Doctors on duty from 9am-5pm:
Average number of Medical Assistants or Nurses on duty from 9am-5pm:
Average number of Front Desk or Check-In staff on duty from 9am-5pm:
Average time well patients spend in the waiting room (in minutes):
Time between scheduled visits (scheduling frequency throughout a day):
Total number of well child visits on any given day:
Number of Exam Rooms:
Technical Information
Internet Access:
Network LAN - Do multiple machines have internet access?
Is there a printer connected to the LAN?
Does the office have on-site or contracted technical support (for computer needs)?