Getting Started With ClientTell Appointment Reminders

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Customer Sign-up Form

Thank You For Choosing ClientTell, Inc.

CONTACT INFORMATION

	Practice Name:	Address:
	City:	State:
	Zip:	Phone:
	Contact:	Title:
	E-Mail:	Fax:

	Back-up Contact:	Title:
	Phone:	E-mail:

ADDITIONAL INFORMATION

	Medical Mgmt. Software:
	Operating System (Windows, Unix,etc):
	Contact:
	Software Support Provider:
	Phone:
	Days in advance to notify patients:	1. , 2. , 3. , 4. , Other
	Number of physicians in your practice:
	How did you find us?

We value your privacy. Your contact information will be kept confidential.

After you complete the steps, ClientTell representative will contact you to begin your service. If you have questions or require assistance, please call us at 1.877.244.9178