Business Name: Your Name: Address: City: State: Zip: Email: Phone Number: 1. Number of records / patients? 2. Average number of pages per record? 3. Are pages added to the records? Yes No 4. How frequently are pages added to the records? 5. Number of new records added each month? 6. Is searching on more than customer name a requirement? (ie. Social security #, street, date, contract #, commonality) Yes No 7. Do you need secure access to your files outside your office? Yes No 8. Legal time requirement to maintain copies of your records? 9. Can the paper records be destroyed after conversion? Yes No 10. How are the pages secured in the folders? 11. Is a scanner / multifunction machine needed? Yes No 12. Is broadband in the office? (Cable Modem, DSL, Wireless, T1) Yes No 13. Are the computers networked? Yes No 14. Is it necessary to transfer files to other businesses securely? Yes No 15. Do you bring work home? Yes No 16. Do you want access to these files from home? Yes No 17. Do you use a billing service? Yes No 18. Which billing service?
Yes No
