EHR Group: Technology Acquisition and Negotiation since 1979

Electronic Health Records and Health IT consulting and education for
Medical groups and practices, community health centers, and community hospitals

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Practice/Group Name*
Address 1*
Address 2
City*
State*
ZIP Code*
Main Phone
Website URL

Primary Contact First Name*
Primary Contact Last Name*
Primary Contact Title or Role*
Primary Contact Email*
Primary Contact Phone*

Secondary Contact First Name
Secondary Contact Last Name
Secondary Contact Title or Role
Secondary Contact Email
Secondary Contact Phone

Practice Type or Specialty*
(check all that apply)


















Other:

# of Locations or Clinics*
# of Physicians*
# of Mid-Levels (NP, PA)*

Do you have IT Staff?

Purchasing Options
(check all that apply)





Preferred EHR Go Live Date (MM/DD/YYYY)
Preferred PM Go Live Date (MM/DD/YYYY)

Current Practice Management System

Primary Vendor Preference(s)*
(check all that apply)










Other:

Secondary Vendor Preference(s)
(check all that apply)











Other:

Technologies or platforms you prefer
(check all that apply)






Other:

Server Hosting Preference
(check all that apply)



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