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(
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*Full name
*Facility Name 
  Position
*Address
*City *State   *Zip 
*Phone No.
  Fax number
*E-mail Address
 *Specialty Area
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How soon you need medical transcription services?   
*Please indicate the number of physicians or other health care professionals who will be using our dictation services:
Individual Less than 5 6 - 10 10 - 20 Over 20
*Type of Facility
Physicians Practice Hospital
Outpatient Clinic Surgery Center
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The transcripts will be sent to you as download from our web site through unique User ID & Password. If you require through any other mode, please specify

The Reports will be worked out and sent in MS Word Format. If you require in Corel WordPerfect, RTF or any other format, please specify

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