Comprehensive Project Profile The information you provide in this form will allow us to prepare a cost analysis for your project. Please be as accurate as possible so we may provide you with the best possible scenario. The prices you receive in your investment analysis are valid for 30 days from the date of preparation. All information provided is kept confidential and is not shared with any outside source besides agreed IT partners.
Completed by: Date: Please return by fax, mail or email to: ifa systems AG Fax: +49-2234-9336730 Email: info@ifasystems.de Practice/hospital name Telephone Address
Fax
City
State/ZIP
Doctor
Admin.
Contact
_____________________________________________________________________________________
Single location
Single hospital
Group hospital
Single location
Multiple locations
# of locations
# of doctors
If multiple locations, are the sites connected via telephone data lines? Yes No DSL ISDN T1 Other Does the practice/hospital currently use a computer system? Network type
Novell
The workstations are:
Unix PCs
or
NT
Yes
No
Other
Dumb terminals
How many PCs are currently in use? ifa systems AG www.ifasystems.com
Phone: +49-2234-933670 Fax: +49-2234-9336730