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Intake form
Help us serve you better
Name
*
Email address
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What type of healthcare practice do you operate?
Please select at least one option.
General Practice
Psychology
Pharmacy
Home Care
Mental Health Clinic
Addiction Services
Home Healthcare Provider
How many personnel are in your practice?
Select
1-5
6-10
11-15
16-20
21-30
What services are you interested in?
Please select at least one option.
On-call schedule management
Virtual assistant for call triage
Automated prioritization and documentation
24/7 real-time response
What is your preferred method of communication?
Please select at least one option.
Phone
Email
Text Message
Video Call
What is your practice's primary location (address)?
Do you require services in multiple languages?
Please select at least one option.
Yes
No
English
Hebrew
Arabic
Which service or services are you interested in?
Please select at least one option.
On-Call schedule management
Virtual assistant for call triage
Automated prioritization and documentation
Additional questions or comments
Submit
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