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Maxsystems: Doctor Information Form
Name:
Clinic:
Address:
Address:
City:
Postal Code:
Phone:
Fax (available only to other doctors):
Mobile (available only to other doctors):
Pager (available only to other doctors):
Practice Type:
Web Site (available only to other doctors):
Email Addresses (available only to other doctors):
Accepting New Patients (Y/N):
Wait Time (in days) For Appointments:
Walk Inís Allowed (Y/N):
House Calls (Y/N):
Lab On Site (Y/N):
X-Ray On Site (Y/N):
EKG On Site (Y/N):
Languages Supported At Your Clinic:
   
 


Contact us!
sales@maxsystems.com
Ph: (204) 786-1460 (ext 210)
Fax: (204) 786-1522

Dealer inquiries welcome!


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