Medwrite Inc.

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Please fill in the following information, so that we can get back to you as soon as possible. Thank you for your keen interest in Medwrite.

Please provide Organization Information:

Name of the Organization

Type of Organization

Contact Person

Designation

Phone No


Email Address	*

Mailing Address

City

State

Country

Zip

Please provide Additional Information

1. What is your Present dictation system?

2. Are you presently outsourcing Medical Transcription Services?

Yes No

If yes with whom

3. When you are planning to upgrade your system?

Immediately < 3 months < 6 months Within 1 Year

3. How many lines does your organization transcribe per month?

< 100K 100K - 250K 250K - 500K 500K - 750K > 750K

4. How did you know out about Medwrite ?