HCS - Apply Online

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Please complete following request to apply online.

First Name*

Last Name*

Organization

Address

City

State*

Zip*

Telephone*

Fax

Email*

Who are your current customers?

Solo physicians

Physician practices (Less than 25 physicians)

Physician practices (25-50 physicians)

Physician practices (50-100 physicians)

Physician practices (More than 100 physicians)

Hospitals (Less than 50 beds)

Hospitals (50-100 beds)

Hospitals (More than 100 beds)

Any Specialties, which you are more familiar selling to?

What all you have been selling
to physician community?

Practice Management (Specify)
Scheduling (Specify)
EDMS (Specify)
Claims Management (Specify)
Transcription Services (Specify)
Remote Billing Services (Specify)
Office / Medical Supplies (Specify)

What is average annual sales volume
of your last 3 years sales to physicians?

How many sales people have
you been employing?

How many technical support
people have you been employing?

What geographic are as are
your strong-holds?

How did you hear about
Health Communication Systems?

Any other comments

( * indicates mandatory fields )

Apply Online