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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 In’s 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: