Clinic Information Questionnaire

This questionnaire will help to enable CaraData to evaluate the data management requirements of your clinic, and to provide an accurate quotation.

Name:
Email:
Phone Number:
Number of Workstations on which SHIP is to be installed?
Number of Clinical and Admin Staff who will use SHIP? (to be used for training purposes)
CaraData will migrate your existing data into SHIP, can you please give us details of the system the clinic is currently using and the approximate number of patients.
Do you have outreach Clinics that would benefit from SHIPWeb If so how many?
Does the Clinic wish to use the SMS Messaging feature of SHIP for patient notification?	Yes No
The Technical Requirements for SHIP 7 are: Microsoft Access (XP or 2003) or option to have the backend in SQL Server 2000. Are these programs currently in use in the Clinic?	Yes No
Is funding available for this project? If so do you have a budget guideline?	Yes No