* =Required Fields
* Name
Company
Address
City
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Zip Code
* Phone
Fax
* Email
Are you currently using any Vendor Software?	Yes No
What are the most important features you are looking for in your future application?
Clinical domain	QA/QI management
Point of care system	User friendly
Scheduling system	Maintenance free
Billing domain	Better cost
Accurate reports	Less errors
Administration suite
Please tell us about your current problems (if any):
* Security Code