LIVE DEMO

We Have Questions.

Now that you know more about us, we would like to know more about you. In order to continue with our demo, we would appreciate it if you took the time to fill out our customer information form.

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CLICKVIEW will use this information to determine who is looking at our website and how to better serve our customers. We intend to use this information internally and will not distribute it to anyone else. It also gives us the opportunity to contact you about new products and services that CLICKVIEW has to offer.

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Contact Information

Practice Information

Department	Please Select Radiology Ultrasound MFM
Primary Site	Please Select Hospital Imaging Center Office/Clinic
Number of Sites	0 1 2 3 4 >5
ULTRASOUND
Number of Scans per Month:
	Ob/Gyn: 0 <50 50-100 101-250 251-500 500-1000 1000-1500 1500-2000 >2000 Vascular: 0 <50 50-100 101-250 251-500 500-1000 1000-1500 1500-2000 >2000 General US:     0 <50 50-100 101-250 251-500 500-1000 1000-1500 1500-2000 >2000
Brand(s) of Scanners ( optional )	Acuson Aloka GE Hitachi Medison Philips Siemens Toshiba Other
Number of Scanners	0 1 2 3 4 5-10 11-15 >15
COMPUTED TOMOGRAPHY
Number of Procedures per Month:
	Head/Brain:     0 <50 50-100 101-250 251-500 500-1000 1000-1500 1500-2000 >2000 Chest: 0 <50 50-100 101-250 251-500 500-1000 1000-1500 1500-2000 >2000 L-S Spine: 0 <50 50-100 101-250 251-500 500-1000 1000-1500 1500-2000 >2000 Abdomen: 0 <50 50-100 101-250 251-500 500-1000 1000-1500 1500-2000 >2000
Current Reporting
PACs: (Type in Vendor Name)
RIS: (Type in Vendor Name)
Current Reporting Method	Please Select None Transcription Voice Recognition Homebrew Database Commercial Database
Please Rank Your Top 3 Needs
Please Select Structured OB Ultrasound Reporting Structured Gyn Ultrasound Reporting Structured General Ultrasound Radiology Reporting Structured Carotid Vascular US Reporting General Radiology Structured Reporting Please Select Structured OB Ultrasound Reporting Structured Gyn Ultrasound Reporting Structured General Ultrasound Radiology Reporting Structured Carotid Vascular US Reporting General Radiology Structured Reporting Please Select Structured OB Ultrasound Reporting Structured Gyn Ultrasound Reporting Structured General Ultrasound Radiology Reporting Structured Carotid Vascular US Reporting General Radiology Structured Reporting
Annual Budget Cycle	Please Select January-December July-June October-September
Plan to Purchase	Please Select This Budget Next Budget Don't Know

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Disclaimer: By clicking Send, you are aware that this is a demonstration of our Internet product and like most demos, it may contain features that have not been completed or addressed. You also agree to our terms and conditions that are outlined here.

 

New Radiology Reports @ RSNA 2006, Booth 5520