Professional Medical Services, Inc.
   
Practice Management, Medical Billing, Transcription
Exceptional Quality & Service

Name of Facility:                                                

Contact Person/Title:  

Telephone Number:                                             E-mail:

In order for PMSI to give you the best possible rate, we need some information (answer only the applicable questions).  You can also download this form as an editable MS Word document. 

How many health practitioners will dictate?

What is the medical specialty of your practice or project?

What will be dictated (letters, reports, documents, forms, etc.)?

What would be the average number of reports per week?

Do you currently have in-house transcription?

What percentage of dictation do you currently outsource?

Would PMSI be your sole provider or for overflow?

Which word processor do you prefer (if applicable)?
   MS Word
   WordPerfect
   Other
   Doesn't matter

Will our service integrate with information systems in place at your site?  If so, please give a brief description.

Will the service be required to transcribe a foreign accent (if yes, please specify)?

Do you require coding and billing in addition to transcription?

When does your current contract expire?

What is your preferred dictation method?
   Hand-held digital recorders
   Other digital recording method
   Existing dictation system
   Remote phone-in
   Open to suggestions                                                                                                       

 What is your preferred delivery method?
   FTP
   Direct modem
   Fax
   E-mail
   Integrated into existing system
   Open to suggestions

If files will be transferred via FTP, do you have an FTP site?

What is your required turnaround?

Describe any problem areas with your current transcription process:

Phone, fax, or e-mail your completed questionnaire.  Your rate quote will arrive via e-mail within 12 business hours. 

Thank you!