DI Logo

Digital Innovation, Inc.

Reliable Medical Registry Solutions
 
DI HOME :: About Us  ::  News & Events  ::  Products  ::  Solutions  ::  Support  ::  Contact Us  ::  Site Map
 

HOME

Collector Users Home

DI Report Writer Information

» Report Writer Request Form

COLLECTR USERS

DI Report Writer Information

> DI Report Writer Request Form

DI Report Writer
Individual Facility Request Form

Collector facilities that are not part of a regional or state-wide Collector system are welcome to request the new DI Report Writer module using this form. A member of DI's Client Services staff will contact you regarding the distribution of your software.

 

FACILITY INFORMATION

    
 

*Facility Name:

Dept. or Div

 
 

*Address Line 1:

Address Line 2:  

  
 

*City: 

*State/Prov: 

*Zip Code: 

  
 

COLLECTOR CONTACT INFORMATION

    
 

*First Name:

*Last Name:

  
 

Title:

*E-mail:

 
 

*Phone Number:

Fax Number:

 
 

COLLECTOR SOFTWARE INFORMATION

  
 

*Installation Setup:

*Mirror System Installed?

 
 

*Workstation(s) Operating System(s):

To select multiple choices, depress the Ctrl key while making selections.

  
 

Network Operating System:

  
 

*Number of Users:

 
 

*Collector Version:

To find your Collector version, open Collector and select HELP | ABOUT. The version number will appear in the "About" window.

  
 

Questions or Comments:

 
 
     
© 2005. Digital Innovation, Inc. All rights reserved.
phone (410) 838-4034  ::  email info@dicorp.com  ::  fax (410) 893-3199