Customer Sign-up Form

Thank you for choosing ClientTell. Please complete the following form to get started with our appointment reminder service. If you have any questions, please contact us at 1.877.244.9178

 

CONTACT INFORMATION
Practice Name
Billing Address
City
State
Zip
Contact Name	The main person responsible for the project
Contact Title
Phone
E-Mail
Back-up Contact	The person who wil be responsible for the file transfer on a daily basis
Backup Phone
Backup E-mail
Practice Mgmt. Software	The name of the software that is used to schedule patients
Software Contact Name	the person who will be responsible for setting up the patient file transfer
Contact Phone
Days in advance to call	1. , 2. , 3. , 4. , Other
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