STAT MEDICAL
TRANSCRIPTION SERVICES, INC.

First Name

Last Name

Phone Number (Optional)

Fax (Optional)

Email Address

Position

Practice or Physician Office Address (Optional)

What Is Your Medical Specialty?

How Many Physicians Will Use Our Service?

How Many Patients Are Seen Each Week?

Which Dictation Method Do You Use? Which Dictation Method Do You Use? Phone-In Dictation Systems Digital Recorder Cell Phone App Other

How Would You Like To Receive Your Finished Documents How Would You Like To Receive Your Finished Documents Secure FTP Fax Other

What Is Your Expected Turnaround Time? What Is Your Expected Turnaround Time? 24 Hours 48 Hours 72 Hours

How Soon Would You Like To Implement Our Service? How Soon Would You Like To Implement Our Service? Immediately Within 2 Weeks Within 1 Month 1 to 2 Months

Please Describe Any Additional Requirements Or Details