Patient Pre-screening Online Order Form for Self Configured Desktops

Schedule a 7 minute phone call assistance to configure my desktop

    Please fill in the following fields and submit your order.

    1.Customer Information

First Name*   Last Name*
Title E-Mail*
Company or Hospital Phone* Ext
City* Province

     2. Please select which interview you'd like from the available list


How to Guide

Self-Check In

3 Weeks Trial

ER Kiosk

Donation Collections

PreSurgical Kiosk

Satisfaction Survey

Family Medicine Units

Financial Transaction

Comments or additional request