Patient Intake and Registration Questionnaire

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  • How soon will you want the documentation flow back into the EHR?
  • Is each site customizing its template differently?
  • Where is your EMR Hosted?
  • Please attach a sample copy of your Patient Registration Forms. NOTE: if you 'Save and Continue' this form later, you will need to re-attach this document.
    Max. file size: 100 MB.
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  • This field is for validation purposes and should be left unchanged.

Need more time? No problem! You can “Save and Continue” your questionnaire later.

Questions? Contact Us!

Phone: (888) 497-4528

Email: [email protected]