7 Medical Demo Form
Referral Partner: Howard Lee Wirehead Technology Tel:773-944-0370 Email:wireheadtec@gmail.com
Name
Address
Phone Number
Email
Type of Practice
Please Select
Single Doctor
Group
Small Clinic
Small Hospital Under 100
beds
Nursing/Group Home
Interested in 7 Medical Services
7i Imaging On Demand
7e Exchange On Demand
7p MDsuite EMR/PM
7s Security Services
7p PRM On Demand
7b Backup & Recovery
7c Computing Services On Demand
Describe Any Compelling Event or Timeline Requirement
Describe the current data/Internet Network and/or applications
List current data/Internet/IT Vendors
List current Vendor and contracts Status for:
Hosting
Medical Imaging
Radiology Info System
Electronic Medical Records
Practice Mgmt. System
Other System
Submit
Should be Empty: