Customer Information
Fields marked with * are required.

Hospital/Imaging Center: *

Address: *

Main Contact: *

 

Phone: *

 

Email: *

Decision Makers:

 
 

Financial (Admin, finance?):

 

Technical (I.S. contact?):

 

Medical (Radiologist Chairman?):

 

Advocates (Who is leading the research/purchase effort?):

 

Note: The same person may be more than one of the above.

Current RIS Environment

    Current Radiology Information System:

     

    When purchased:

     

    Current Version:

         

    Current Billing System or Software:

     

    Is Billing Centralized:

     

    How Many FTE’s in Billing:

         

    What Scheduling Software in Use:

     

    Is Scheduling Centralized:

     

    How many FTE’s in Billing:

         

    PACS:

     

    When Purchased:

     

    Current Version: