Type of Facility *
Select one Medical Orthopedic Urology Chiropractic Veterinary

Monthly Film Volume *


Number of Patients per Month? *


Average Reimbursement per patient series?


Type of X-ray System in use?
Select one Conventional Anolog High Frequency single phase High Frequency three phase

Does it have AEC (Automatic Exposure Control)?
Yes
No

Does existing x-ray table and or wall stand have the following:
Select one Super/Hi-speed bucky Par speed bucky Stationary grid(s)

Type of Digital System of interest? (CR, CCD, DR) *
Select one CR (Computed Radiography) DR (Direct Digital Radiography) CCD (Charged Coupled Device)

How many Viewing Stations are required?


Type of Workstations?
Select one Convential tower Lap top Tablet pc Macintosh

High Resolution monitors 3MP +?
Yes
No

Speech Recognition?
Yes
No

Laser Printer?
Yes
No

Film Digitizer for scanning existing films?
Yes
No

How many Doctors? *


What other Radiographic Modalities are currently being utilized? (MRI, CT, etc.)


Will PACS be considered?
Yes
No

Does your facility utilize EMR ? (Electronic Medical Records) *
Yes
No

Will you have EMR in the Future?
Yes
No

Will Radiology Information System (RIS) be in the future?
Yes
No

Insurance, image tracking, dictation, scheduling?
Yes
No

Additional comments


Information Requested by: *


Facility Name, Account Name (or account #): *


City: *


State: *


Phone: *


Your email: *